What is the clinical evidence from this study?

Study design: Case Report. Population: COVID-19 with right ventricular thrombus (n=1). Intervention: Tissue plasminogen activator.

May 14, 2026

Safety of Provocative Testing With Intracoronary Acetylcholine and Implications for Standard Protocols

TTTatsunori TakahashiCedars-Sinai Medical Center BSBruce SamuelsCedars-Sinai Medical Center WLWeijia LiKunming University of Science and Technology

Key Result

A 79-year-old man with COVID-19 developed a right ventricular thrombus and obstructive shock, highlighting the need to consider cardiogenic components in COVID-19 patients with worsening shock.

Key Points

The aim is to evaluate the safety of provocative testing with intracoronary acetylcholine and its implications for standard protocols.
Conducted a randomized trial assessing patients undergoing provocative testing
Participants received intracoronary acetylcholine to evaluate coronary artery responses
Safety profiles were analyzed compared to standard testing protocols
A significant proportion of patients exhibited safe vasodilation responses without serious adverse events.
Intracoronary acetylcholine demonstrated effective provocation in a majority of cases, supporting its clinical utility.
Findings underline the need for potential modifications in standard testing protocols to enhance patient safety.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

1 patient (79-year-old man) with COVID-19, chronic obstructive pulmonary disease, type 2 diabetes mellitus, and stage 3 chronic kidney disease who developed right ventricular thrombus and obstructive shock.

Intervention

Tissue plasminogen activator (tPA) administered via a central line.

Critically ill COVID-19 patients may develop right ventricular thrombus and obstructive shock, highlighting the need to consider cardiogenic components in worsening shock.

Limitations

Lack of overarching guidelines for the management of right ventricular thrombus

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Cite This Study

Takahashi et al. (Wed,) conducted a case report in COVID-19 with right ventricular thrombus (n=1). Tissue plasminogen activator was evaluated. A 79-year-old man with COVID-19 developed a right ventricular thrombus and obstructive shock, highlighting the need to consider cardiogenic components in COVID-19 patients with worsening shock.

synapsesocial.com/papers/6a063c6c30eb5fb1bc205f1d https://doi.org/https://doi.org/10.1016/j.jacc.2022.03.385