Myocardial infarction caused by ostial right coronary artery thrombus in the absence of atheromatosis.

Myocardial infarction in patients with normal coronary vessels is a relatively rare entity that is observed in up to 2.8% of patients with myocardial infarction. In this case, we present a patient in whom presence of thrombus was suspected by pressure damping during engagement of the right coronary ostium despite the normal angiographic morphology. Further contrast injections with the catheter resting outside the ostium and intravascular imaging with optical coherence tomography helped confirm the suspicion of ostial thrombosis, as well as the presence of non-atheromatic vascular wall. The patient was consequently treated with thrombus aspiration and stenting of the vessel ostium.