Complete Resolution of High-Burden Thrombus in an Ectatic Right Coronary Artery with Triple Antithrombotic Therapy

58 year-old man was admitted with acute inferior myocardial infarction. One and a half million units of streptokinase were administered. The patient did not experience any other episode of chest pain. Coronary angiography performed 48 hours after admission showed normal left anterior descending and left circumflex arteries. Right coronary artery (RCA) contrast injection revealed an ectatic vessel with a large filling defect consistent with thrombus at its mid portion. Considering the patients stable condition, urgent intervention was avoided and triple therapy with Plavix, aspirin and enoxaparin was started. Control angiography 6 days later revealed complete trhrombous resolution. This case study shows that with proper case selection serious consequences of early invasive intervention such as distal embolization and no-reflow in these high risk patients could be avoided.