Management of Acute Coronary Syndrome in Severe Diffuse Coronary Artery Ectasia: A Therapeutic Challenge.

BACKGROUND: Coronary artery ectasia (CAE) predisposes to abnormal flow, thrombosis, and adverse cardiovascular outcomes. CASE SUMMARY: A 72-year-old woman with diffuse multivessel CAE, systemic arterial ectasia, and psoriasis presented with inferior ST-segment elevation myocardial infarction in the setting of left bundle branch block. Angiography demonstrated an approximately 8-mm ectatic right coronary artery with complete thrombotic occlusion. Aspiration thrombectomy restored partial flow, but stenting was deferred because of diffuse ectasia, persistent thrombus, and malapposition risk. She was discharged on a direct oral anticoagulant plus single antiplatelet therapy. DISCUSSION: Diffuse CAE is a high-risk thrombotic substrate, and ST-segment elevation myocardial infarction management is challenging because of altered flow, large thrombus burden, and percutaneous coronary intervention limitations. TAKE-HOME MESSAGE: Diffuse systemic ectasia warrants individualized antithrombotic therapy and longitudinal imaging surveillance.