Performing intravascular procedures in highly inflammatory patients: think twice

The co-occurrence of aortic thrombi following a coronary angiography in a highly inflammatory patient raises the suspicion of inflammation-induced arterial thrombosis subsequent to endothelial cell injury. An overwhelming inflammatory response will increase the levels of coagulation factor VIII - produced by the endothelium and acting as an acute phase protein - and thus the tendency to form blood clots, especially after local damage to the endothelial cells by guidewire or catheter manipulation. Within this case report, we underscore the importance of adopting a cautious strategy when contemplating invasive arterial procedures, or even postpone when not urgently needed, in patients with strongly elevated levels of inflammation. Here, factor VIII levels can act as a guidance even before C-reactive protein levels rise. These interventions carry the risk of causing endothelial cell injury, consequently amplifying the probability of arterial thrombus formation, with a challenging management and treatment.