A case of acute coronary syndrome caused by a giant saddle thrombus at left main coronary artery bifurcation

• Published in: Journal of cardiology cases Vol. 3; no. 2; pp. e86 - e89
• Main Authors: Suzuyama, Hiroto, MD, Taguchi, Eiji, MD, PhD, Miyamoto, Shinzo, MD, PhD, Nuki, Toshiaki, MD, Nozoe, Masatsugu, MD, Sawamura, Tadashi, MD, Sakamoto, Tomohiro, MD, PhD, Nakao, Koichi, MD, PhD, FJCC
• Format: Journal Article
• Language: English
• Published: Japan Japanese College of Cardiology 01.04.2011
• Subjects: Cardiovascular; 320-Row area detector computed tomography; Acute coronary syndrome; Coronary thrombus; Left main coronary artery bifurcation
• ISSN: 1878-5409; 1878-5409
• DOI: 10.1016/j.jccase.2011.01.003

Summary An 87-year-old woman who had metastatic lung cancer presented with intermittent chest discomfort. The emergent coronary angiogram showed a giant saddle thrombus at the left main coronary artery bifurcation without flow limitation. We performed thrombolysis with unfractionated heparin and warfarin under careful observation of the thrombus with a 320-row area detector computed tomography (ADCT). Ten days later, the second examination with ADCT revealed complete resolution of the saddle thrombus. During the follow-up, neither chest pain nor enzymatic cardiac damage was reported. In this carefully observed case, a less invasive strategy instead of catheter intervention or strong thrombolysis might have led to a favorable clinical outcome.