Case report of penetrating coronary artery ulcer of the right coronary artery in a middle-aged man presenting with recurrent chest pain
4 affiliations
- 1Division of Cardio Nephrology, Cardiac Renal & Renal Vascular Associates
- 2Cardiology Department, Community Hospital , Caribbean Tristate Heart Institute
- 3General Medicine Department, Iwosan Lagoon Hospitals
- 4Ternopil State Medical University
Abstract
Background Penetrating Coronary artery ulcers (PCAU) are rarely reported disruption of vascular wall integrity believed to arise from plaque rupture. Its clinical presentation often mimics other acute coronary syndromes, making timely recognition challenging. Despite their potential association with adverse cardiovascular events, they are poorly understood and no consensus guideline for their management exists. Case Summary 64-year-old man with complex medical history including a prior coronary artery disease with stent implantation, who presented with recurrent chest pain. Cardiac catheterization identified a grade II penetrating ulcer of the proximal right coronary artery with no obstructive lesions, and he was subsequently managed conservatively with good outcome. Discussion Penetrating coronary artery ulcers are rare clinical findings with no specific treatment guidelines. Given the limited evidence base and the potential for progression to dissection, thrombosis, or myocardial ischemia, detailed reporting of PCAU presentations is essential to guide clinical practice. Further research is crucial to develop evidence-based treatment guidelines, especially with the advancements in intravascular imaging. Conclusion Penetrating coronary artery ulcer remains a rare but clinically important condition. Early recognition with multimodality imaging and individualized management strategies are key to preventing adverse outcomes. This report expands the existing evidence base and provides valuable reference material for clinicians facing similar scenarios.
Related
- Spontaneous Bilateral Vesical Artery Pseudoaneurysms Presenting With Massive Recurrent Hematuria and Obstructive Acute Kidney Injury: A Case Report
- Refractory Multivessel Coronary Artery Spasm Unresponsive to Renal Sympathetic Denervation, with Recurrent Transient ST-Segment Elevation and an Episode of Accelerated Idioventricular Rhythm: A Case Report.
- Spontaneous coronary artery dissection presenting as myocardial infarction in a postmenopausal woman
- Coronary artery disease polygenic risk score and recurrent cardiovascular events after coronary artery revascularization: A UK Biobank analysis
- Saphenous Vein Graft-to-Pulmonary Artery Fistula Presenting With Coronary Ischemia and Right Ventricular Dysfunction
BibTeX
@article{badero2026case,
title = {{Case report of penetrating coronary artery ulcer of the right coronary artery in a middle-aged man presenting with recurrent chest pain}},
author = {Olurotimi J. Badero and Bamikole T. Osibowale and Pelumi V. Ajayi and Sandra Bakare},
journal = {Journal of Cardiothoracic Surgery},
year = {2026},
month = jul,
doi = {10.1186/s13019-026-04559-y},
url = {https://doi.org/10.1186/s13019-026-04559-y},
note = {CC BY},
}
RIS
TY - JOUR
TI - Case report of penetrating coronary artery ulcer of the right coronary artery in a middle-aged man presenting with recurrent chest pain
AU - Olurotimi J. Badero
AU - Bamikole T. Osibowale
AU - Pelumi V. Ajayi
AU - Sandra Bakare
PY - 2026
DA - 2026/07/01
JO - Journal of Cardiothoracic Surgery
DO - 10.1186/s13019-026-04559-y
UR - https://doi.org/10.1186/s13019-026-04559-y
AB - Background Penetrating Coronary artery ulcers (PCAU) are rarely reported disruption of vascular wall integrity believed to arise from plaque rupture. Its clinical presentation often mimics other acute coronary syndromes, making timely recognition challenging. Despite their potential association with adverse cardiovascular events, they are poorly understood and no consensus guideline for their management exists. Case Summary 64-year-old man with complex medical history including a prior coronary artery disease with stent implantation, who presented with recurrent chest pain. Cardiac catheterization identified a grade II penetrating ulcer of the proximal right coronary artery with no obstructive lesions, and he was subsequently managed conservatively with good outcome. Discussion Penetrating coronary artery ulcers are rare clinical findings with no specific treatment guidelines. Given the limited evidence base and the potential for progression to dissection, thrombosis, or myocardial ischemia, detailed reporting of PCAU presentations is essential to guide clinical practice. Further research is crucial to develop evidence-based treatment guidelines, especially with the advancements in intravascular imaging. Conclusion Penetrating coronary artery ulcer remains a rare but clinically important condition. Early recognition with multimodality imaging and individualized management strategies are key to preventing adverse outcomes. This report expands the existing evidence base and provides valuable reference material for clinicians facing similar scenarios.
SN - 1749-8090
ER -