Thrombosed aneurysmal right coronary artery presenting as inferior STEMI: A comprehensive review and case report of diagnosis, imaging and management

Abstract

Coronary artery aneurysms (CAAs) are rare vascular disorders characterized by localized dilatation of a coronary artery segment, often leading to severe complications such as thrombosis, embolization, and rupture. This case report discusses a thrombosed aneurysmal right coronary artery (RCA) presenting as an inferior STEMI. A 61-year-old male presented with chest pain and diaphoresis. An ECG revealed inferior STEMI, and emergent coronary angiography (CAG) identified a large RCA aneurysm (2.14 x 1.4 cm) with significant thrombus and distal occlusion. PCI was performed, including aspiration thrombectomy and balloon angioplasty, followed by dual antiplatelet therapy (DAPT) and anticoagulation. Echocardiography confirmed the aneurysm and showed mildly reduced ejection fraction. Follow-up CAG demonstrated thrombus resolution, and the patient remained asymptomatic over 1.5 years. Thrombosed RCA aneurysms are challenging to diagnose due to varied presentations mimicking acute coronary syndromes. Imaging modalities such as echocardiography, cardiac CT, and CAG are crucial for accurate diagnosis and management. Treatment strategies include surgical resection, percutaneous interventions, and medical therapy, tailored to the patient’s clinical and imaging findings.Thrombosed RCA aneurysms require prompt diagnosis and intervention. Advanced imaging and a tailored treatment approach are essential for optimal outcomes. This case highlights the importance of comprehensive management in patients with CAA-associated STEMI.

Keywords: Right Coronary artery aneurysm, ST-elevation myocardial infarction, Thrombosis