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[Intravascular ultrasound-guided diagnosis after transmural anterior ischemia and cardiogenic shock]
1Schüchtermann-Klinik, Herzzentrum Osnabrück-Bad Rothenfelde, Ulmenallee 11, 49214 Bad Rothenfelde, Germany. guido_luedorff@yahoo.de
Insights
Acute coronary syndrome with cardiogenic shock has high mortality. Intravascular ultrasound (IVUS) diagnosed a ruptured plaque in the left main stem, guiding therapy in a patient without significant stenosis post-thrombolysis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Acute coronary syndrome (ACS) complicated by cardiogenic shock presents a significant mortality risk.
- Timely coronary angiography is crucial for guiding therapeutic decisions in ACS.
- Thrombolysis is a common treatment for ACS, but may not always reveal underlying pathology.
Observation:
- This report details a case of ACS where coronary angiography did not show high-grade stenosis after thrombolysis.
- Intravascular ultrasound (IVUS) examination was pivotal in identifying the cause of the patient's condition.
- A ruptured plaque in the left main stem was diagnosed using IVUS.
Findings:
- IVUS provided critical diagnostic information beyond conventional angiography in this ACS case.
- The findings highlight the utility of IVUS in diagnosing non-obstructive coronary artery disease complications.
- Ruptured plaque in the left main stem, even without high-grade stenosis, can precipitate severe ACS.
Implications:
- This case underscores the importance of considering advanced imaging like IVUS when clinical presentation is discordant with angiographic findings.
- Accurate diagnosis of plaque rupture, regardless of stenosis severity, is essential for appropriate management of ACS.
- Therapeutic strategies for ACS may need to be tailored based on IVUS-detected plaque characteristics.
Abstract:
Acute coronary syndrome, if complicated by cardiogenic shock, has a high mortality. Urgent coronary angiography is important for decision of therapy. The present paper reports on a patient without angiographically high grade stenosis after thrombolysis. The intravascular ultrasound examination (IVUS) was important for diagnosis of ruptured plaque of the left main stem. Therapy options are discussed.