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Abstract Background Acute coronary syndrome due to coronary artery embolism in the setting of ascending aortic thrombus is an uncommon condition, even rarer when there is no aortic pathology such as aneurysm, severe atherosclerosis, aortic dissection, or thrombophilia (whether inherited or acquired). Case presentation We report a case of a 58-year-old male presented with acute chest pain, electrocardiogram showing non-ST-elevation acute coronary syndrome. The computed tomography angiography of coronary artery revealed a mural thrombus in the proximal part of ascending aorta, located above the left coronary artery ostium, without any aortic pathologies. With the exception of hypertension and cigarette smoking, no other risk factors were identified in this patient that may increase the risk of thrombosis. Given the life-threatening risk of interventional therapy and surgery, the patient determinedly opted for anticoagulant and dual antiplatelet therapy. Then he experienced the reoccurrence of chest pain after 6-day treatment, progressed to anterior and inferior ST-segment elevation myocardial infarction. Coronary artery embolism originating from the ascending aortic thrombus was suspected. Considering the hemodynamic instability of the patient, the medical treatment was continued and bridged to warfarin and aspirin after discharge. Follow-up computed tomography angiography at 6 months showed no obstruction in coronary artery and complete resolution of the thrombus. No thromboembolic events occurred henceforward. Conclusions Acute coronary syndrome could be a manifestation of secondary coronary embolism due to ascending aortic thrombus. Currently, there is no standardized guideline for the treatment of aortic mural thrombus, individualized treatment is recommended. When surgical therapy is not applicable for the patient, anticoagulation and dual antiplatelet treatment are alternative treatments that may successfully lead to the resolution of the aortic thrombus.

Background: Acute coronary syndrome due to coronary artery embolism in the setting of ascending aortic thrombus is an uncommon condition, even rarer when there is no aortic pathology such as aneurysm, severe atherosclerosis, aortic dissection, or thrombophilia (whether inherited or acquired). Case presentation: We report a case of a 58-year-old male presented with acute chest pain, electrocardiogram showing non-ST-elevation acute coronary syndrome. The computed tomography angiography of coronary artery revealed a mural thrombus in the proximal part of ascending aorta, located above the left coronary artery ostium, without any aortic pathologies. With the exception of hypertension and cigarette smoking, no other risk factors were identified in this patient that may increase the risk of thrombosis. Given the life-threatening risk of interventional therapy and surgery, the patient determinedly opted for anticoagulant and dual antiplatelet therapy. Then he experienced the reoccurrence of chest pain after 6-day treatment, progressed to anterior and inferior ST-segment elevation myocardial infarction. Coronary artery embolism originating from the ascending aortic thrombus was suspected. Considering the hemodynamic instability of the patient, the medical treatment was continued and bridged to warfarin and aspirin after discharge. Follow-up computed tomography angiography at 6 months showed no obstruction in coronary artery and complete resolution of the thrombus. No thromboembolic events occurred henceforward. Conclusions: Acute coronary syndrome could be a manifestation of secondary coronary embolism due to ascending aortic thrombus. Currently, there is no standardized guideline for the treatment of aortic mural thrombus, individualized treatment is recommended. When surgical therapy is not applicable for the patient, anticoagulation and dual antiplatelet treatment are alternative treatments that may successfully lead to the resolution of the aortic thrombus. [ABSTRACT FROM AUTHOR]

A patient had a stroke caused by a large, pedunculated aortic ascending mass and was deemed at high risk for near-term recurrent stroke. This case illustrates percutaneous aspiration thrombectomy of ascending aortic thrombus with the AngioVac system (Angiodynamics, Latham, New York), with conscious sedation for early stroke detection and with endovascular cerebral embolic protection. (Level of Difficulty: Intermediate.)

We report a particularly interesting case in which a free-floating thrombus of unknown origin in the ascending aorta and extending into aortic arch with each heart beat was attached to a mildly atherosclerotic aortic wall. The thrombus was thought to have been the origin of a previous right axillary artery thrombo-embolism. The thrombus was removed directly from ascending aorta after putting the patient on circulatory arrest; the axillary artery thrombus was also removed simultaneously from the same incision with the help of Fogarty catheter placed antegradely. [ABSTRACT FROM AUTHOR]

Although an ascending aortic thrombus is a rare condition, it can cause serious complications of thromboembolism. Here we present a rare case of a patient who was hospitalized due to ileal arteries embolization caused by emboli from a giant thrombus in the ascending aorta. After 10 days anti-coagulation therapy, we performed a surgery to replace the ascending aorta containing the strip organized thrombus with a synthetic graft. During two years of postoperative follow-up, no recurrence of aortic thrombosis was found. Although the exact cause of this thrombus remains unclear, we believe that it is important to perform a surgery as soon as the presence of an ascending aortic thrombus is confirmed, which could help preventing the major recurrent embolic events. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) initiates a hypercoagulable state and causes thrombotic complications. A presentation of multiple thromboembolic events without an underlying source should raise suspicion for COVID-19 hypercoagulability. We describe a patient with an ascending aortic thrombus resulting in multiple emboli treated by multiple modalities. [ABSTRACT FROM AUTHOR]