CASE PRESENTATION: A 49-year-old Japanese man with history of
splenic infarction of unknown cause had continued
anticoagulant therapy since its diagnosis, but stopped taking the medication several months ago. He presented with sudden-onset chest dorsalgia. Contrast computed tomography showed a small
pulmonary embolism and his
troponin I level was elevated on initial laboratory test. Coronary angiography revealed a contrast defect caused by a large
thrombus from the proximal to mid portion of the left anterior descending artery. Near-infrared spectroscopy-intravascular ultrasonography showed a large amount of
thrombus without
lipid plaque. Therefore, revascularization was performed using a
thrombus-aspiration
catheter and intracoronary thrombolysis. In addition, ,
hyperhomocysteinemia and a
deep vein thrombosis occurred. He was diagnosed with
acute coronary syndrome complicated with
pulmonary embolism and
deep vein thrombosis simultaneously induced by
hyperhomocysteinemia. After 1 week of antithrombotic
therapy, near-infrared spectroscopy-intravascular ultrasonography and optical coherence tomography revealed a decreased
thrombus and no significant residual organic
stenosis in the left anterior descending artery. He continued
conservative therapy with antithrombotic medications including
aspirin and
warfarin and had no cardiovascular events after discharge. Follow-up coronary angiography and optical coherence tomography at 9 months revealed complete disappearance of the
thrombus and no severe
stenosis.
CONCLUSIONS: