Key Clinical Message:
Coronary embolism (CE), though rare, is an essential yet often
overlooked cause of acute myocardial infarction. When CE arises from
left ventricular thrombus (LVT), as demonstrated in this case, rapid
diagnosis and targeted intervention are crucial. Aspiration thrombectomy
is an effective, minimally invasive strategy to swiftly restore coronary
flow.
CE is a rare yet significant contributor to acute myocardial infarction
(AMI), particularly in younger patients. We report a 42-year-old male
who experienced an AMI following recent cocaine use. Investigations
revealed a left ventricular apical thrombus, identified as the source of
a distal embolus occluding the right coronary artery (RCA). Cocaine is
known for its thrombogenic effects, promoting thrombus formation through
mechanisms such as vasoconstriction and increased platelet aggregation.
This unique situation highlights the critical interplay between cocaine
use, left ventricular thrombus formation, and the resultant coronary
artery embolism, contributing to myocardial ischemia. The patient
underwent successful aspiration thrombectomy, restoring coronary blood
flow without the need for stenting. This case underscores the importance
of recognizing CE as a potential etiology of AMI, particularly in the
context of substance abuse, advocating for heightened awareness among
clinicians regarding the complexities of managing thromboembolic events.
Keywords: Coronary Embolism, Left Ventricular Thrombus,
Cocaine, Aspiration Thrombectomy