Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2022; 10(31): 11508-11516
Published online Nov 6, 2022. doi: 10.12998/wjcc.v10.i31.11508
Extensive right coronary artery thrombosis in a patient with COVID-19: A case report
Clarissa Campo Dall’Orto, Rubens Pierry Ferreira Lopes, Mariana Torres Cancela, Ciria de Sales Padilha, Gilvan Vilella Pinto Filho, Marcos Raphael da Silva
Clarissa Campo Dall’Orto, Rubens Pierry Ferreira Lopes, Gilvan Vilella Pinto Filho, Marcos Raphael da Silva, Therapy Center, Brazilian Society of Health Support Hospital, Teixeira de Freitas 45987-088, Bahia, Brazil
Mariana Torres Cancela, Department of Cardiology, Deputy Luis Eduardo Magalhães Hospital, Porto Seguro 45810-000, Bahia, Brazil
Ciria de Sales Padilha, Intensive Care Unit, Medical Assistance Extreme South Hospital, Eunápolis 45820-131, Bahia, Brazil
Author contributions: Dall’Orto CC and Lopes RPF contributed to manuscript writing, editing and supervision; Pinto Filho GV and Raphael M contributed to data analysis; Cancela MT contributed to conceptualization; de Sales Padilha C contributed to data collection; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Clarissa Campo Dall’Orto, MD, PhD, Chief Doctor, Therapy Center, Brazilian Society of Health Support Hospital, Av. Pres. Getúlio Vargas-Recanto do Lago 2752, Teixeira de Freitas 45987-088, Bahia, Brazil. clarissadallorto@alumni.usp.br
Received: May 12, 2022
Peer-review started: May 12, 2022
First decision: June 27, 2022
Revised: July 27, 2022
Accepted: September 21, 2022
Article in press: September 21, 2022
Published online: November 6, 2022
Abstract
BACKGROUND

Occurring in approximately 30% of hospitalized patients, cardiovascular complications that take place during the course of coronavirus disease 2019 (COVID-19) have been shown to cause morbidity and mortality. This case is the first report of extensive right coronary artery (RCA) thrombosis that was evaluated by intracoronary imaging and intracoronary invasive physiology in a patient with COVID-19.

CASE SUMMARY

A 62-year-old woman presented with flu-like symptoms; ten days later, she presented with inferior ST-segment elevations, chest pain, dyspnea, nausea and vomiting. The patient was diagnosed with COVID-19 following a positive test result. Emergency angiography of the RCA and its branches indicated intraluminal filling defects, suggesting a thrombus. Intravascular ultrasound confirmed a subacute thrombus in the RCA, the right posterior descending branch and the right posterior ventricular (RPV) branch. There was also an acute thrombus in the RPV branch and atherosclerosis in the RCA. Dual antiplatelet/ anticoagulation therapy was administered. After 7 d, angiography revealed complete disappearance of the thrombi. Optical coherence tomography confirmed this with the exception of a small thrombus in the RPV branch and atherosclerotic plaque in the RCA. The atherosclerotic RCA was measured using the resting full-cycle ratio, indicating no impairment to coronary physiology. The patient was discharged on the 11th day of hospitalization and remained asymptomatic through the 6-mo follow-up.

CONCLUSION

This was the first report of RCA thrombosis in a patient with COVID-19. Dual antiplatelet/anticoagulation therapy was successful.

Keywords: Acute coronary syndrome, Coronary angiography, COVID-19, Intravascular ultrasound, Thrombosis, Case report

Core Tip: Cardiovascular complications occurring during the course of coronavirus disease 2019 (COVID-19) cause morbidity and mortality. We report the case of a 62-year-old woman with COVID-19 and ST-elevation myocardial infarction. Angiography of the right coronary artery suggested a thrombus, and findings were confirmed via intravascular ultrasound and optimal coherence tomography. Dual antiplatelet therapy and anticoagulation with enoxaparin therapy was administered for 7 d, followed by disappearance of the thrombi. Resting full-cycle ratio was performed without damage to coronary physiology. There is no consensus on the ideal management approach for acute coronary syndrome in this scenario; however, in this case the thrombi disappeared after dual antiplatelet and anticoagulation therapy.