Medical management for coronary embolism post-AVR: An alternative to invasive therapies

We describe the case of a 47-year-old male patient who developed acute coronary syndrome caused by coronary artery embolism occurring nine days after a febrile episode. His past medical history included hypertension, dyslipidemia, type 2 diabetes mellitus, and mechanical aortic valve replacement performed 16 years previously. Coronary angiography revealed a sizable thrombus involving the left main coronary artery with extension into the left anterior descending artery, while distal coronary perfusion remained preserved. A diagnosis of coronary embolism was considered most likely, with prosthetic valve thrombosis and infective endocarditis included in the differential diagnosis. The patient was managed medically using anticoagulation, dual antiplatelet therapy, and empiric antibiotic treatment, without requiring invasive thrombectomy or thrombolytic therapy. Subsequent follow-up imaging demonstrated complete disappearance of the thrombus, and the patient remained free of symptoms, highlighting that conservative therapy may be an effective strategy in selected patients with coronary embolism.