RESUMEN
COVID-19 has been associated with cardiovascular events. This case demonstrates severe left main coronary artery thrombosis with distal embolisation in a young male patient admitted with COVID-19 who developed ST-elevation myocardial infarction. The patient was treated with thrombus aspiration combined with aggressive anticoagulant treatment, which yielded complete resolution of the thrombus. Left main thrombus represents a life-threatening coronary event and is most often associated with atherosclerotic plaque rupture. In this case, however, we suspect that COVID-19-related intimal inflammation and hypercoagulopathy might be the causal mechanism of thrombus formation. Revascularisation with coronary artery bypass grafting or percutaneous coronary intervention is the standard treatment of left main thrombosis. However, due to the patient's young age and lack of significant atherosclerotic disease burden, we used a conservative medical treatment strategy using potent antithrombotic therapy.
Asunto(s)
COVID-19 , Trombosis Coronaria , Infarto del Miocardio con Elevación del ST , COVID-19/complicaciones , Tratamiento Conservador , Trombosis Coronaria/complicaciones , Trombosis Coronaria/diagnóstico por imagen , Trombosis Coronaria/terapia , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/cirugía , Humanos , MasculinoRESUMEN
We present a case of heavy lone coronary thrombosis in the setting of COVID-19 infection. We highlight the special angiographic, ultrasonographic, and histological features of this thrombus, and we describe the application of carotid stent retriever for its removal.
Asunto(s)
COVID-19 , Trombosis Coronaria , Trombosis Coronaria/diagnóstico por imagen , Trombosis Coronaria/etiología , Trombosis Coronaria/terapia , Vasos Coronarios , Humanos , SARS-CoV-2 , Stents , Trombectomía , Resultado del TratamientoRESUMEN
Since the start of the COVID-19 pandemic, several cases have reported extensive multivessel coronary thrombosis as a cardiovascular manifestation of SARS-CoV-2 infection. This case describes a patient who developed non-ST elevation myocardial infarction during hospitalization for acute hypoxic respiratory failure due to COVID-19. We review the immediate and delayed revascularisation strategies of culprit and non-culprit lesions in the setting of high intracoronary thrombus burden induced by SARS-CoV-2. Successful percutaneous intervention and stenting of a culprit lesion and resolution of an intracoronary thrombus using a delayed strategy of lesion passivation with adjuvant pharmacotherapy are demonstrated on index and follow-up angiography.
Asunto(s)
COVID-19 , Trombosis Coronaria , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Angiografía Coronaria , Trombosis Coronaria/diagnóstico por imagen , Trombosis Coronaria/terapia , Humanos , Pandemias , SARS-CoV-2 , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Infarto del Miocardio con Elevación del ST/cirugía , Resultado del TratamientoAsunto(s)
COVID-19 , Trombosis Coronaria , Infarto del Miocardio , Intervención Coronaria Percutánea , COVID-19/complicaciones , Angiografía Coronaria , Trombosis Coronaria/complicaciones , Trombosis Coronaria/diagnóstico por imagen , Trombosis Coronaria/terapia , Humanos , Infarto del Miocardio/terapia , SARS-CoV-2 , Trombectomía , Resultado del TratamientoAsunto(s)
Vacuna BNT162/efectos adversos , COVID-19/prevención & control , Angiografía Coronaria/métodos , Oclusión Coronaria , Trombosis Coronaria , Tomografía de Coherencia Óptica/métodos , Adulto , Anafilaxia/diagnóstico , Anafilaxia/etiología , Anafilaxia/fisiopatología , Vacuna BNT162/administración & dosificación , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/etiología , Oclusión Coronaria/diagnóstico por imagen , Oclusión Coronaria/tratamiento farmacológico , Oclusión Coronaria/etiología , Oclusión Coronaria/fisiopatología , Trombosis Coronaria/diagnóstico por imagen , Trombosis Coronaria/tratamiento farmacológico , Trombosis Coronaria/etiología , Trombosis Coronaria/fisiopatología , Diagnóstico Diferencial , Terapia Antiplaquetaria Doble/métodos , Electrocardiografía/métodos , Inhibidores del Factor Xa/administración & dosificación , Humanos , Masculino , SARS-CoV-2 , Resultado del Tratamiento , Vacunas Virales/administración & dosificación , Vacunas Virales/efectos adversosRESUMEN
COVID-19 is a prothrombotic condition that is also associated with raised troponin levels and myocardial damage. We present a case of a 54-year-old man who was admitted with respiratory failure due to COVID-19 and developed a ST-elevation myocardial infarction (STEMI) during his admission. His coronary angiogram did not show any significant coronary artery disease other than a heavily thrombosed right coronary artery. In view of heavy thrombus burden, the right coronary artery was treated with thrombus retrieval using a distal embolic protection device in addition to manual thrombectomy and direct (intracoronary) thrombolysis without the need for implantation of a coronary stent. After successful revascularisation, triple antithrombotic therapy was instituted with an oral anticoagulant in addition to dual antiplatelets. This case illustrates the association of COVID-19 with coronary artery thrombosis, which may require disparate management of a STEMI than that resulting from atherosclerotic coronary artery disease.
Asunto(s)
COVID-19 , Trombosis Coronaria , Infarto del Miocardio , Infarto del Miocardio con Elevación del ST , Trombosis Coronaria/complicaciones , Trombosis Coronaria/diagnóstico por imagen , Vasos Coronarios , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/etiología , SARS-CoV-2 , Infarto del Miocardio con Elevación del ST/etiologíaAsunto(s)
COVID-19/complicaciones , Trombosis Coronaria , Intervención Coronaria Percutánea/efectos adversos , Infarto del Miocardio con Elevación del ST , Tomografía de Coherencia Óptica , Arterias , Trombosis Coronaria/diagnóstico por imagen , Humanos , SARS-CoV-2 , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Infarto del Miocardio con Elevación del ST/terapia , Resultado del TratamientoRESUMEN
COVID-19 has varied cardiovascular manifestations including microvascular and macrovascular thrombi leading to multiorgan system injury and failure. This case describes a patient presenting with acute hypoxaemic respiratory failure from COVID-19 who abruptly developed a large thrombus in the right coronary artery leading to myocardial infarction. This case report reviews the ECG, heart catheterisation images prepercutaneous and postpercutaneous coronary intervention, critical care management and outcome in the context of the height of the COVID-19 pandemic in the Virginia area. A brief review of relevant literature regarding cardiovascular complications of COVID-19 is also provided. Unfortunately, the patient ultimately passed after 2 weeks of inability to wean off the ventilator.
Asunto(s)
COVID-19/complicaciones , Trombosis Coronaria/etiología , Infarto del Miocardio con Elevación del ST/etiología , Angiografía , COVID-19/diagnóstico por imagen , Cateterismo Cardíaco , Trombosis Coronaria/diagnóstico por imagen , Trombosis Coronaria/cirugía , Diagnóstico Diferencial , Stents Liberadores de Fármacos , Electrocardiografía , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Pandemias , Radiografía , SARS-CoV-2 , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Infarto del Miocardio con Elevación del ST/cirugía , TrombectomíaAsunto(s)
Trombosis Coronaria , Enfermedad Injerto contra Huésped , Infarto del Miocardio con Elevación del ST , Trombosis , Arritmias Cardíacas , Trombosis Coronaria/diagnóstico por imagen , Trombosis Coronaria/etiología , Electrocardiografía , Humanos , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Infarto del Miocardio con Elevación del ST/etiología , Espasmo , Trombosis/diagnóstico por imagen , Trombosis/etiologíaRESUMEN
We describe the case of a healthy patient with moderate COVID-19 infection without thrombophilia nor coronary disease background who presented with a relapsing thrombotic occlusion of the right coronary artery despite normal oxygenation, adequate antiaggregation and prophylactic anticoagulation. Prophylactic anticoagulation recommendations in COVID-19 were inadequate for this patient. Further data are needed to propose full-dose therapeutic anticoagulation for patients with coronary thrombosis and COVID-19 infection. This could nevertheless be considered even in mild forms of COVID-19.
Asunto(s)
COVID-19/complicaciones , Oclusión Coronaria/etiología , Trombosis Coronaria/etiología , Anticoagulantes/uso terapéutico , COVID-19/fisiopatología , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Oclusión Coronaria/diagnóstico por imagen , Oclusión Coronaria/prevención & control , Trombosis Coronaria/diagnóstico por imagen , Trombosis Coronaria/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , SARS-CoV-2 , Tratamiento Farmacológico de COVID-19RESUMEN
Coronavirus 2019 (COVID-19) is an acute respiratory disease that has rapidly spread around the world and been declared a global pandemic by the World Health Organization. Emerging evidence demonstrates a strong association with a pro-thrombotic state and we present the first patient admitted with COVID-19 and an inferior ST-segment elevation myocardial infarction (STEMI) with evidence of high intracoronary thrombus burden. We review the mechanism of the high thrombus burden, which may be driven by the significant cytokine storm, endothelial dysfunction, increase risk of coronary plaque rupture and hypercoagulability.
Asunto(s)
COVID-19 , Trombosis Coronaria , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Trombosis Coronaria/diagnóstico por imagen , Humanos , SARS-CoV-2 , Infarto del Miocardio con Elevación del ST/diagnóstico por imagenAsunto(s)
Trombosis Coronaria/complicaciones , Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , Infarto del Miocardio con Elevación del ST/etiología , Betacoronavirus , COVID-19 , Angiografía Coronaria , Trombosis Coronaria/diagnóstico por imagen , Trombosis Coronaria/terapia , Infecciones por Coronavirus/diagnóstico , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Pandemias , Intervención Coronaria Percutánea , Neumonía Viral/diagnóstico , SARS-CoV-2 , Infarto del Miocardio con Elevación del ST/terapia , Tomografía Computarizada por Rayos XRESUMEN
Consideration of thrombolysis as first-line reperfusion therapy in patients with COVID-19 and STEMI is recommended by ACC/SCAI guidelines. We describe a patient with COVID-19, who presented with ST-elevation myocardial infarction and was treated with thrombolysis and anticoagulation. He was later found to have a significant persistent thrombus burden requiring thrombectomy and stent placement. Invasive hemodynamics on multiple high-dose pressers revealed a high cardiac output state with low systemic vascular resistance, consistent with distributive rather than cardiogenic shock. Our case illustrates that thrombolytic therapy alone may not be adequate in patients with STEMI and COVID-19, as well as the importance of early invasive hemodynamics in management of shock in patient with STEMI and COVID-19 infection.
Asunto(s)
Trombosis Coronaria/terapia , Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , Infarto del Miocardio con Elevación del ST/terapia , Trombectomía , Terapia Trombolítica/métodos , Anticoagulantes/uso terapéutico , Betacoronavirus , COVID-19 , Angiografía Coronaria , Trombosis Coronaria/diagnóstico por imagen , Electrocardiografía , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Intervención Coronaria Percutánea , SARS-CoV-2 , Infarto del Miocardio con Elevación del ST/diagnóstico por imagenAsunto(s)
Bronquiectasia/etiología , COVID-19/complicaciones , Trombosis Coronaria/etiología , Neumotórax/etiología , Embolia Pulmonar/etiología , Bronquiectasia/diagnóstico por imagen , Trombosis Coronaria/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Neumotórax/diagnóstico por imagen , Embolia Pulmonar/diagnóstico por imagenAsunto(s)
Trombosis Coronaria/etiología , Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , COVID-19 , Angiografía Coronaria , Trombosis Coronaria/diagnóstico , Trombosis Coronaria/diagnóstico por imagen , Trombosis Coronaria/terapia , Humanos , Persona de Mediana Edad , PandemiasRESUMEN
BACKGROUND: Few data are available on the rate and characteristics of thromboembolic complications in hospitalized patients with COVID-19. METHODS: We studied consecutive symptomatic patients with laboratory-proven COVID-19 admitted to a university hospital in Milan, Italy (13.02.2020-10.04.2020). The primary outcome was any thromboembolic complication, including venous thromboembolism (VTE), ischemic stroke, and acute coronary syndrome (ACS)/myocardial infarction (MI). Secondary outcome was overt disseminated intravascular coagulation (DIC). RESULTS: We included 388 patients (median age 66 years, 68% men, 16% requiring intensive care [ICU]). Thromboprophylaxis was used in 100% of ICU patients and 75% of those on the general ward. Thromboembolic events occurred in 28 (7.7% of closed cases; 95%CI 5.4%-11.0%), corresponding to a cumulative rate of 21% (27.6% ICU, 6.6% general ward). Half of the thromboembolic events were diagnosed within 24 h of hospital admission. Forty-four patients underwent VTE imaging tests and VTE was confirmed in 16 (36%). Computed tomography pulmonary angiography (CTPA) was performed in 30 patients, corresponding to 7.7% of total, and pulmonary embolism was confirmed in 10 (33% of CTPA). The rate of ischemic stroke and ACS/MI was 2.5% and 1.1%, respectively. Overt DIC was present in 8 (2.2%) patients. CONCLUSIONS: The high number of arterial and, in particular, venous thromboembolic events diagnosed within 24 h of admission and the high rate of positive VTE imaging tests among the few COVID-19 patients tested suggest that there is an urgent need to improve specific VTE diagnostic strategies and investigate the efficacy and safety of thromboprophylaxis in ambulatory COVID-19 patients.