# ST-Elevation Myocardial Infarction in a Young Man With Moyamoya Disease

## TL;DR

A young man with moyamoya disease experienced a heart attack due to unique coronary artery changes, highlighting the importance of recognizing this condition in young patients.

## Contribution

The paper presents a novel case linking moyamoya disease to acute myocardial infarction through coronary spasm and thrombus formation.

## Key findings

- Moyamoya disease can cause acute myocardial infarction via fibrous intimal thickening and thrombus formation.
- Optical coherence tomography is crucial for diagnosing non-traditional plaque morphology in moyamoya-related heart attacks.
- Systemic vascular disorders like moyamoya should be considered in young patients with acute coronary syndrome.

## Abstract

Moyamoya disease causes vasculopathic changes not only in intracranial arteries but also in extracranial vessels, including coronary arteries.

A 25-year-old man collapsed from ventricular fibrillation and was resuscitated. Coronary angiography revealed left anterior descending artery occlusion, and optical coherence tomography demonstrated diffuse intimal thickening and thrombus formation without plaque rupture. Percutaneous intervention restored coronary flow. Subsequent evaluations revealed vasospastic angina and moyamoya disease.

This case highlights the unique pathophysiological mechanism of acute myocardial infarction in moyamoya disease, where fibrous intimal thickening predisposes to coronary spasm and thrombus formation, distinct from traditional atherosclerotic processes. Optical coherence tomography played a key role in identifying plaque morphology, guiding diagnosis, and management.

Recognition of systemic vascular disorders, such as moyamoya disease, is essential in young patients with acute coronary syndrome to improve outcomes and prevent recurrence.