Recurrent Myocardial Infarctions Due to Thrombosis of a Coronary Aneurysm in Neurofibromatosis Type 1: Is Antiplatelet Treatment Enough?

A 68-year-old woman was admitted for an anterolateral myocardial infarction (MI). She had neurofibromatosis type 1 (NF-1) and 2 previous hospitalizations for non–ST-segment elevation MI, medically treated. In those episodes, aneurysmal coronary arteries with fresh thrombus in left anterior descending artery (LAD) were described. Emergent coronary angiography (CA) revealed a giant aneurysm in the mid-LAD with multiple small fresh thrombi (Figures 1A to 1C, Online Videos 1, 2, and 3). There were Thrombolysis In Myocardial Infarction flow grade 3 and no significant stenosis. Aneurysmal dilations without significant stenosis were also observed in the right coronary and circumflex arteries (Figures 1A to 1D). Triple antiplatelet therapy (aspirin, clopidogrel, abciximab [intracoronary bolus and 12-h perfusion]) and anticoagulation (enoxaparine 60 mg bid) were administered. One week later, scheduled CA showed a complete angiographic resolution of the thrombus (Figures 1E and 1F, Online Videos 4 and 5). No percutaneous coronary intervention (PCI) was performed. Given that this episode was the third MI in aneurysmal