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Acute coronary occlusion with impending infarction as an angiographic complication relieved by a guide-wire
Insights
This study presents a combined approach for acute coronary artery occlusion, averting myocardial infarction through early recanalization and bypass surgery. While successful in this case, the technique
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- A 45-year-old male with prior myocardial infarction and unstable angina presented with two-vessel coronary artery disease.
- Coronary angiography identified significant lesions in the left anterior descending (LAD) and right coronary artery (RCA).
- During angiography, the RCA acutely occluded, precipitating signs of impending reinfarction.
Observation:
- The patient experienced clinical and electrocardiographic signs of acute inferior reinfarction following RCA occlusion.
- Successful recanalization of the occluded RCA was achieved using a guide-wire and Sones catheter.
- Patient symptoms and ischemic electrocardiographic changes resolved rapidly within eight minutes post-recanalization.
Findings:
- Aortocoronary bypass surgery revascularized both the LAD and RCA within three hours of recanalization.
- Postoperative assessment showed no significant myocardial tissue loss by enzyme or electrocardiographic criteria.
- Follow-up angiography confirmed a widely patent graft to the RCA, with preserved left ventricular function.
Implications:
- The combined strategy of early transluminal recanalization and subsequent bypass surgery averted extensive left ventricular necrosis.
- This case demonstrates a potential life-saving intervention for acute coronary artery occlusion during diagnostic procedures.
- Widespread adoption of this technique is cautioned against pending further investigation and validation.
Abstract:
In a 45 year old male patient with a history of previous inferior myocardial infarction and unstable angina pectoris, coronary angiography revealed two-vessel disease: a 60-70% lesion in the middle third of the LAD, and a 90% lesion in the middle third of the very large RCA. There was only a small akinetic segment in the posterobasal region of the left ventricle. During angiography total occlusion of the RCA occurred followed the clinical and electrocardiographic signs of impending inferior reinfarction. Recanalization of the occluded vessel was accomplished by using a guide-wire, which was passed through a Sones catheter, placed in the RCA. The patient's symptoms subsided and the electrocardiographic signs of acute ischemia reverted within eight minutes. Aortocoronary bypass surgery with revascularization of the LAD and RCA was performed within 3 hours after recanalization. Postoperatively there was no evidence of major tissue loss by enzyme or electrocardiographic criteria. Control angiography, performed on the ninth day postoperatively, revealed the graft to the RCA to be widely patent. Left ventricular function was unchanged. It is concluded, that the combined approach of early transluminal recanalization of the acutely occluded RCA followed by successful construction of a graft to this vessel, has averted necrosis of a major portion of the left ventricle. However, general use of this technique does not seem advisable at the present time.