Progressive Dilation of Coronary Artery Ectasia Causing Recurrent Myocardial Infarction

Figures

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  Figure 1. Coronary Angiography at the First Time of Myocardial Infarction (15 Years Ago) (A) Angiography shows the occlusion of the distal part of the right coronary artery (red arrowheads; LAO 0, CRA 26). (B) The left coronary artery is also ectatic with associated slow flow without stenosis or thrombus (LAO 0, CRA 27). (C) Coronary angiography after the antithrombotic therapy for 1 month shows that the thrombus has diminished at the distal part and coronary flow has improved (LAO 0, CRA 30). CRA = cranial; LAO = left anterior oblique.

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  Figure 2. Electrocardiography at the Emergency Department The electrocardiogram shows ST-segment elevation of the inferior leads.

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  Figure 3. Coronary Angiography at the Recurrent Myocardial Infarction Angiography shows (A) total occlusion of the middle right coronary artery (LAO 40, CRA 0) and (B) ectasia of the left coronary artery (LAO 0, CRA 30) as well. (C) After the recanalization, coronary flow is restricted at the focal stenosis (blue arrowheads; LAO 0, CRA 10). (D) The final angiogram after stent implantation (yellow dotted line) remains thrombus and flow limitation at the distal part. (LAO 0, CRA 29). CRA = cranial; LAO = left anterior oblique.

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  Figure 4. The Changes in the Diameters of Coronary Arteries Over 15 Years Measured by Quantitative Coronary Angiography Analysis Compared with (left) the previous myocardial infarction (MI) 15 years before (LAO 40, CRA 0), angiography at (right) the second MI shows a more dilated coronary artery (LAO 41, CRA 0). CRA = cranial; LAO = left anterior oblique.

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  Figure 5. Coronary Computed Tomographic Angiography After Primary Percutaneous Coronary Intervention Computed tomography shows the remained thrombus (purple-colored area) but the coronary flow is preserved up to the distal part (stent: turquoise-colored area; LAO 55, CRA 3). CRA = cranial; LAO = left anterior oblique.

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  Figure 6. Coronary Angiography 12 Months After Second Myocardial Infarction Angiography reveals that the thrombus has disappeared without flow limitation or stent (yellow dotted line) restenosis (left: LAO 40, CRA 0; right: LAO 0, CRA 30). CRA = cranial; LAO = left anterior oblique.