Coronary Embolism With Fragmented Thrombus From the Left Ventricle in Patient With Postinfarction Aneurysm

The thrombus formation in the left ventricle (LV) cavity is a frequent complication of myocardial infarction (MI) as well as a risk factor for peripheral arterial embolism. Probability of intraventricular thrombus depends on MI location and its therapy. A case of coronary embolism in a patient with anterior MI and thrombus in the LV aneurysm is considered in details. Successful percutaneous coronary intervention (PCI) in the first 90 minutes after admission was performed. Decision to appoint a three-component antithrombotic therapy (acetylsalicylic acid, clopidogrel, warfarin) was made on the 4th day of disease onset taking into account the combination of MI, stent placement in the anterior interventricular artery and the presence of left ventricular aneurysm with parietal thrombus. Recurrence of MI developed on the 9th day of disease onset. Aspiration thromboembolectomy was performed taking into account thrombosis of two coronary arteries. Warfarin therapy was discontinued in connection with subsequent clot lysis and development of not intensive nosebleed. Subsequent MI course was uneventful. In conclusion, even in spite of the timely achievement of PCI and early reperfusion, MI course can be complicated by thrombosis of the left ventricle and subsequent development of thromboembolic complications.