Du BB, Wang XT, Tong YL, Liu K, Li PP, Li XD, Yang P, Wang Y. Optical coherence tomography guided treatment avoids stenting in an antiphospholipid syndrome patient: A case report. World J Clin Cases 2020; 8(11): 2399-2405 [PMID: 32548174 DOI: 10.12998/wjcc.v8.i11.2399]
Corresponding Author of This Article
Ying Wang, MD, Attending Doctor, Department of Cardiology, The Third Hospital of Jilin University, Jilin Provincial Cardiovascular Research Institute, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, No. 126, Xiantai Street, Changchun 130031, Jilin Province, China. wangying2020@jlu.edu.cn
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jun 6, 2020; 8(11): 2399-2405 Published online Jun 6, 2020. doi: 10.12998/wjcc.v8.i11.2399
Optical coherence tomography guided treatment avoids stenting in an antiphospholipid syndrome patient: A case report
Bei-Bei Du, Xing-Tong Wang, Ya-Liang Tong, Kun Liu, Pei-Pei Li, Xiang-Dong Li, Ping Yang, Ying Wang
Bei-Bei Du, Ya-Liang Tong, Kun Liu, Pei-Pei Li, Xiang-Dong Li, Ping Yang, Ying Wang, Department of Cardiology, The Third Hospital of Jilin University, Jilin Provincial Cardiovascular Research Institute, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
Xing-Tong Wang, Department of Hematology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Author contributions: Du BB, Wang Y, and Li PP were the patient’s physicians; Du BB, Tong YL, and Li XD performed the coronary angiography and coronary intervention; Tong YL and Liu K helped with acquisition of the data; Du BB, Wang XT, and Wang Y reviewed the literature and contributed to manuscript drafting; Du BB, Wang XT, and Wang Y were responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ying Wang, MD, Attending Doctor, Department of Cardiology, The Third Hospital of Jilin University, Jilin Provincial Cardiovascular Research Institute, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, No. 126, Xiantai Street, Changchun 130031, Jilin Province, China. wangying2020@jlu.edu.cn
Received: February 19, 2020 Peer-review started: February 19, 2020 First decision: April 29, 2020 Revised: April 29, 2020 Accepted: May 14, 2020 Article in press: May 14, 2020 Published online: June 6, 2020 Processing time: 110 Days and 0 Hours
Abstract
BACKGROUND
Increasing attention has been paid to acute myocardial infarction (AMI) in young female patients for whom secondary factors should be considered during the diagnostic process. Anti-phospholipid syndrome (APS), a rare autoimmune disease that is most common in young female patients, is reportedly related to AMI. To date, coronary interventions, particularly stenting, remains controversial in this special clinical scenario.
CASE SUMMARY
A 26-year-old female patient was admitted to hospital for acute chest pain, palpitations, and dyspnea. She had a past medical history of APS and pulmonary embolism. Coronary angiography showed acute occlusion of the proximal left anterior descending artery. After repeated thrombus aspirations, residual thrombus and mild stenosis were found in the proximal left anterior descending artery. Optical coherence tomography (OCT) was done, which confirmed the non-atherosclerosis coronary thrombosis and an intact intima in this patient. Deferring or avoiding stenting based on follow-up intracoronary findings with intensified antithrombotic treatment was chosen. One week later, coronary angiography and OCT confirmed an intact intima with no injury and no residual thrombus. The 3-mo telephone follow-up reported a good prognosis.
CONCLUSION
APS can cause acute non-atherosclerosis coronary thrombosis which presents as an AMI in young female patients. Intracoronary OCT findings can guide interventional strategies in this special clinical scenario.
Core tip: Acute myocardial infarction secondary to antiphospholipid syndrome in young female patients has been reported but not well studied. Coronary intervention, particularly stenting, is still in controversy in this special clinical scenario. Up to now, no specific management, especially intracoronary findings regarding this disease, has been reported. Here we present the direct evidence of acute coronary thrombosis with no atheroma in a young female acute myocardial infarction patient with antiphospholipid syndrome. Also, this case showed good in-hospital recovery with no stenting and intensified antithrombotic treatment using serial optical coherence tomography examinations.
