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- Received October 26, 2009
- Accepted November 5, 2009
- Published online April 13, 2010.
Intracoronary thrombi represent an important aspect of the pathophysiology of acute coronary syndromes. Their presentation and management differ depending on the clinical presentation. We present a case with an unusual angiographic presentation of a coronary thrombus in the left main coronary artery, which was managed with coronary artery bypass grafting. A 45-year-old male patient was admitted due to intermittent recent-onset chest pain and inferolateral ST-segment elevation. A coronary angiogram revealed a highly mobile “mass” that had a somewhat rubbery appearance in the left main coronary artery ostium (A and B, Online Videos 1and 2). Due to the size, mobility, and uncertain nature of the “mass” and risk of embolization, emergency surgery was selected. Coronary artery bypass grafting to the left anterior descending artery and obtuse marginal artery was performed using venous grafts. After an aortotomy, the mass was moved into the aorta by means of antegrade graft irrigation (thereby irrigating native arteries retrogradely) and was removed afterward. Pathological examination revealed the mass to be a thrombus. The patient recovered uneventfully without any residual wall motion abnormalities.
- Received October 26, 2009.
- Accepted November 5, 2009.
- American College of Cardiology Foundation