Septic Coronary Embolism Presenting as Anterior STEMI: A Stentless PCI Strategy Guided by Clinical Inconsistency and Pathological Confirmation – Case Report

Figures

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  Figure 1. Coronary angiography. Abrupt occlusion of the mid–left anterior descending artery with a smooth, tapering contour and no angiographic evidence of underlying atherosclerotic plaque, raising suspicion of a non-atherosclerotic mechanism.

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  Figure 2. Intravascular ultrasound. A large, homogeneous intraluminal thrombus without calcification or atherosclerotic plaque. The vessel wall appears smooth and intact, inconsistent with plaque rupture or erosion.

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  Figure 3. Pathological examination of the aspirated thrombus. Hematoxylin–eosin staining demonstrating basophilic (purple) microcolonies arranged in grape-like clusters within a fibrin-rich thrombus, consistent with Gram-positive cocci such as methicillin-sensitive Staphylococcus aureus.

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  Figure 4. Two-dimensional transesophageal echocardiography. (A) Mid-oesophagal long-axis view showing perforation of the left coronary cusp without colour Doppler, demonstrating the anatomical defect caused by infective endocarditis. (B) Colour Doppler imaging demonstrates a simultaneous eccentric aortic regurgitation jet originating from the perforation, indicating acute valve failure.

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  Figure 5. Three-dimensional transesophageal echocardiography. En-face 3D view clearly delineating perforation of the left coronary cusp, providing structural confirmation of the anatomical defect responsible for acute severe aortic regurgitation.