Management of Acute Coronary Syndrome in Severe Diffuse Coronary Artery Ectasia
- 1Department of Internal Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
- 2Department of Cardiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
Abstract
Background: Coronary artery ectasia (CAE) predisposes to abnormal flow, thrombosis, and adverse cardiovascular outcomes.
Case Summary: A 72-year-old woman with diffuse multivessel CAE, systemic arterial ectasia, and psoriasis presented with inferior ST-segment elevation myocardial infarction in the setting of left bundle branch block. Angiography demonstrated an approximately 8-mm ectatic right coronary artery with complete thrombotic occlusion. Aspiration thrombectomy restored partial flow, but stenting was deferred because of diffuse ectasia, persistent thrombus, and malapposition risk. She was discharged on a direct oral anticoagulant plus single antiplatelet therapy.
Discussion: Diffuse CAE is a high-risk thrombotic substrate, and ST-segment elevation myocardial infarction management is challenging because of altered flow, large thrombus burden, and percutaneous coronary intervention limitations.
Take-Home Message: Diffuse systemic ectasia warrants individualized antithrombotic therapy and longitudinal imaging surveillance.
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BibTeX
@article{gonnah2026management,
title = {{Management of Acute Coronary Syndrome in Severe Diffuse Coronary Artery Ectasia}},
author = {Ahmed Reda Gonnah and Fahdem Iamrl and Douglas Jacoby and Allison L. Tsao and Mahesh K. Vidula and Daniel E. Soffer and Monika Sanghavi},
journal = {JACC Case Reports},
year = {2026},
month = sep,
doi = {10.1016/j.jaccas.2026.110203},
url = {https://doi.org/10.1016/j.jaccas.2026.110203},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Management of Acute Coronary Syndrome in Severe Diffuse Coronary Artery Ectasia
AU - Ahmed Reda Gonnah
AU - Fahdem Iamrl
AU - Douglas Jacoby
AU - Allison L. Tsao
AU - Mahesh K. Vidula
AU - Daniel E. Soffer
AU - Monika Sanghavi
PY - 2026
DA - 2026/09/11
JO - JACC Case Reports
DO - 10.1016/j.jaccas.2026.110203
UR - https://doi.org/10.1016/j.jaccas.2026.110203
AB - Background: Coronary artery ectasia (CAE) predisposes to abnormal flow, thrombosis, and adverse cardiovascular outcomes. Case Summary: A 72-year-old woman with diffuse multivessel CAE, systemic arterial ectasia, and psoriasis presented with inferior ST-segment elevation myocardial infarction in the setting of left bundle branch block. Angiography demonstrated an approximately 8-mm ectatic right coronary artery with complete thrombotic occlusion. Aspiration thrombectomy restored partial flow, but stenting was deferred because of diffuse ectasia, persistent thrombus, and malapposition risk. She was discharged on a direct oral anticoagulant plus single antiplatelet therapy. Discussion: Diffuse CAE is a high-risk thrombotic substrate, and ST-segment elevation myocardial infarction management is challenging because of altered flow, large thrombus burden, and percutaneous coronary intervention limitations. Take-Home Message: Diffuse systemic ectasia warrants individualized antithrombotic therapy and longitudinal imaging surveillance.
SN - 2666-0849
ER -