Successful removal of a left main coronary artery thrombus induced by vasospasm of the aorta after the injection of contrast medium

A 52-year-old woman with acute myocardial infarction underwent emergency co ronary angiography. The patient had an episode of idiopathic thrombocytopen ic purpura, and underwent splenectomy at the age of 36. On admission, plate let count in the peripheral blood was 43.2 x 10(4)/mul. During the initial emergency left coronary angiography, a thrombus was detected in the left ma in trunk. The thrombus was drawn back to the orifice of the left coronary a rtery, and finally disappeared into the aorta by injecting contrast media. After the thrombus disappeared, no stenotic lesion was detected in the left coronary artery. One month later, when acetylcholine provocation coronary angiography was performed, marked vasospasm was detected in the left corona ry arteries. Coronary thrombosis in the patient might have been induced by a coronary spasm, and the presence of thrombocytosis might also have affect ed the development of a coronary thrombus. However, it was spontaneously dr awn back to the aorta by back flow of contrast media, which was injected vi a the entrance of the left coronary artery. A case of acute myocardial infa rction whose thrombus occluded the left main coronary artery and was remove d at first injection of contrast media is presented.