Introduction:
Coronary embolism (CE) is a significant yet underrecognized contributor
to acute myocardial infarction (AMI), with prevalence estimates between
4% and 13% in angiographic and autopsy studies 1.
Current literature indicates that intracoronary thrombus formation
following plaque rupture due to atherosclerosis is the most common
mechanism of myocardial infarction; however, non-atherosclerotic causes,
such as CE, must also be considered 2,3. The
management for CE differs from atherosclerotic causes, despite similar
clinical presentations. In cases of CE, aspiration thrombectomy and
balloon angioplasty are preferred, unlike AMI due to atherosclerosis,
where coronary stenting is often indicated 4.
CE involves embolic material, such as thrombi, infectious elements, or
neoplastic fragments, circulating to and obstructing the coronary
arteries, leading to infarction of the myocardium supplied by the
affected arteries. Multiple etiologies can give rise to CE, including
paradoxical emboli from atrial septal defects, iatrogenic emboli from
cardiothoracic procedures, and direct embolization from thrombi
originating in the cardiac ventricles 5. To our
knowledge, no cases of the latter have been reported in the literature,
particularly in the context of cocaine abuse, highlighting the
significance of this case report as a valuable contribution to to the
literature.
Cocaine is recognized for its thrombogenic and angiospastic effects,
promoting thromboembolism through several mechanisms6. Thrombi originating in the left ventricle or atrium
are generally more likely to travel to the carotids or distal systemic
circulation, given the linear course from the left ventricular outflow
tract. However, coronary vessels are anatomically more protected from
embolic events 7, making CE originating from a cardiac
thrombus exceedingly rare, a factor that further underscores the
uniqueness of our case.
Here, we present a rare case of a 42-year-old male who presented with
chest pain following cocaine use. Investigations revealed an embolus
obstructing the right coronary artery and a left ventricular apical
thrombus on transthoracic echocardiography, which was proposed to be the
embolic source, for which he underwent a successful aspiration
thrombectomy.