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Updated: Jul 16, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Prominent myocardial bridging as a first clue to recognize haemorrhagic shock during percutaneous coronary
Mio Aono1, Toru Miyoshi1, Akinori Higaki1
1Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa 454, Toon, Ehime 791-0295, Japan.
Insights
A rare complication of percutaneous coronary intervention (PCI) is puncture site hemorrhage, which can induce myocardial bridging. Prompt diagnosis and coil embolization resolved the hemorrhage and the induced myocardial bridging.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Percutaneous coronary intervention (PCI) is a common procedure for treating coronary artery disease.
- Hemorrhage at the puncture site is a known but serious complication of PCI.
- Early detection and management of hemorrhage are crucial to prevent further complications.
Observation:
- A 73-year-old man developed myocardial bridging in the left anterior descending artery after undergoing PCI.
- The induced myocardial bridging was not present before the intervention.
- Lower limb arteriography revealed contrast media extravasation at the right inferior epigastric artery, indicating puncture-related hemorrhage.
Findings:
- Coil embolization of the right inferior epigastric artery successfully treated the hemorrhage.
- The induced myocardial bridging resolved within four months post-procedure.
- This case highlights a potential link between hemorrhage and myocardial bridging during PCI.
Implications:
- Hemorrhage at the puncture site may lead to dynamic changes in coronary arteries, such as myocardial bridging.
- Prompt recognition and intervention for hemorrhage are essential to prevent adverse outcomes.
- Further research is warranted to understand the mechanisms linking hemorrhage to myocardial bridging.
Background:
Haemorrhage at the puncture site is a serious complication of percutaneous coronary intervention (PCI).
Case Summary:
A 73-year-old man underwent transfemoral intervention because of stable angina pectoris. After a rotational atherectomy, an everolimus-eluting stent was implanted from the left main trunk to the proximal site of the left anterior descending (LAD) artery. We also recognized that myocardial bridging was significantly induced at the middle portion of the LAD, which was not evident before the PCI. We suspected puncture-related haemorrhage and immediately performed lower limb arteriography. As a result, contrast media extravasation was observed at the branch of the right inferior epigastric artery. Finally, we performed coil embolization into the left common femoral artery, and the extravasation successfully disappeared. Four months later, he underwent coronary angiography. There were no findings of myocardial bridging.
Discussion:
Myocardial bridging during a PCI procedure may indicate hypercontraction because of haemorrhage.
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