Proximal right coronary artery diverticulum resulting in recurrent distal embolization

This is a case of a right coronary artery (RCA) diverticulum. We highlight the complications of distal embolization and recurrent myocardial infarctions (MI), and the successful closure with a covered stent. A 33-year-old Khat user experienced non-ST elevation MI (non-STEMI) 3 times over 2 years. His first cardiac catheterization showed a proximal RCA ulceration. The last catheterization revealed a proximal RCA diverticulum containing a thrombus, and a thrombus at the distal PDA. A covered Jomed? stent (Jomed International AB) was placed into the proximal RCA, closing the diverticulum, and preventing future embolizations. Patient's atherosclerotic ulceration led to diverticular disease that resulted in blood flow stasis, thrombi, distal embolization, and repeat acute coronary events.