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Acute coronary occlusion during coronary angiography in two cases. Treatment by transluminal disobliteration
Insights
Sudden coronary artery obstruction during angiography can cause cardiac arrest. Promptly opening the blocked artery with a guide-wire and potentially streptokinase can lead to rapid recovery.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Coronary angiography is a common diagnostic procedure.
- Acute coronary obstruction is a rare but serious complication.
- Cardiac ischemia and collapse can occur during angiography.
Observation:
- Two patients experienced acute coronary obstruction during coronary angiography.
- Obstruction occurred in the left main coronary artery and near the left anterior descending artery origin.
- Both patients developed electromechanical dissociation and collapse unresponsive to resuscitation.
Findings:
- Successful rapid disobliteration of the occluded coronary artery was achieved using a guide-wire.
- Recanalization was completed with intracoronary streptokinase in one case.
- Both patients showed rapid and spectacular recovery after the intervention.
Implications:
- Accidental coronary occlusion should be considered in cases of acute ischemia during angiography.
- Transluminal disobliteration is a viable and simple technique for managing acute coronary occlusion.
- Prompt intervention can reverse life-threatening conditions and improve patient outcomes.
Abstract:
Acute coronary obstruction occurred in two patients during coronary angiography. In one case the obstruction was in the left main coronary artery; in the other it was close to the origin of the left anterior descending artery. In both cases acute cardiac ischaemia ensued, with electromechanical dissociation and collapse, which was not reversible by resuscitation. Rapid disobliteration of the occluded coronary artery was done with a guide-wire pushed through the obstruction via the coronary catheter. The recanalisation was completed by an intracoronary perfusion of streptokinase in one case. In both cases recovery was rapid and spectacular. The occurrence of acute ischaemia during coronary angiography should suggest accidental coronary occlusion. If a thromboembolic origin is suspected, transluminal disobliteration should be attempted. It is simple and can reverse a dangerous condition.