Title

Aggressive acute coronary thrombosis in ulcerative colitis flare.

Document Type

Conference Proceeding

Publication Date

3-2020

Publication Title

J Am Coll Cardiol

Abstract

Background Thromboembolic disease is a well-recognized complication of Ulcerative Colitis (UC), but coronary involvement is rare. Chest pain in UC flare should raise suspicion for acute coronary thrombosis. Case A 46 year old male with UC was admitted after 3 weeks of bloody diarrhea despite treatment with prednisone. He also reported severe refractory chest pain. ECG showed ST-segment elevation myocardial infarction in inferior/lateral leads. Emergent left heart catheterization (LHC) revealed a large thrombus in mid left anterior descending (LAD) artery with distal embolization. Aspiration thrombectomy was unsuccessful. A drug eluting stent (DES) was placed in mid-LAD. Intracoronary vasodilators improved distal coronary flow. The patient was continued on DAPT. Five days later, his chest pain recurred. Decision-making LHC showed acute in-stent thrombosis. Two DES were placed in overlapping fashion to proximal-mid LAD with PTCA on the diagonal. Persistent thrombus was treated with balloon inflations. The patient continued to be symptomatic, so an intra-aortic balloon bump (IABP) was placed. He was continued on DAPT. Hemodynamics and chest pain improved in next 2 days, and IABP was removed. Conclusion Acute coronary thrombosis in pro-inflammatory states are challenging to treat, since both the underlying condition and treatment of UC are pro-thrombotic. Close monitoring and consideration of mechanical support devices may improve coronary perfusion while controlling the underlying flare.

Volume

75

Issue

11

First Page

3302

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