How should I treat?

How should I treat a very large thrombus burden in the infarct-related artery in a young patient with an unexplained lower GI tract bleeding?

EuroIntervention 2011;7:754-763. DOI: 10.4244/EIJV7I6A119

Piotr Musialek
Piotr Musiałek1,2*, MD, DPhil; Łukasz Tekieli2, MD, PhD; Piotr Pieniążek1,2, MD, PhD; Anetta Undas3, MD PhD; Tomasz Miszalski-Jamka4, MD, PhD; Wojciech Zajdel2, MD; Piotr Klimeczek4, MD, PhD; Bartosz Laskowicz4, MD; R. Paweł Banyś4, MSc(Eng) ; Mieczysław Pasowicz4, MD, PhD; Piotr Podolec1, MD, PhD
1. Jagiellonian University Institute of Cardiology, Department of Cardiac and Vascular Diseases, Krakow, Poland; 2. John Paul II Hospital, Centre for Interventional Treatment of Cardiovascular Diseases, Krakow, Poland; 3. Jagiellonian U

BACKGROUND: A 35-year-old man was referred to us in his third hour of severe retro-sternal pain, with ventricular fibrillation on paramedics’ arrival. No contraindications to pPCI were revealed on telephone referral. Direct questioning on cathlab admission, however, revealed the recurrent presence of small amounts of fresh blood in the stools, with the last episode two hours prior to admission.

INVESTIGATION: Physical examination, ECG, laboratory tests, coronary angiography, thrombophilia screening, VH-IVUS, cMRI.

DIAGNOSIS: Ectatic coronary arteries. Acute inferior STEMI as a result of thrombotic occlusion of RCA, with a very large thrombus burden. Recurrent, non-diagnosed, lower ...

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