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[Two cases of acute myocardial infarction with simultaneous occlusions of two main coronary branches]
Insights
This study details two rare cases of acute myocardial infarction involving simultaneous blockages in two major coronary arteries. Hypercoagulability and reduced coronary blood flow are proposed as the underlying mechanisms.
Area of Science:
- Cardiology
- Vascular Medicine
- Medical Case Reports
Background:
- Acute myocardial infarction (AMI) typically involves occlusion of a single coronary artery.
- Simultaneous occlusion of two main coronary branches is exceptionally rare, posing diagnostic and therapeutic challenges.
Abstract:
We report two rare cases of acute myocardial infarction with simultaneous occlusion of two main coronary branches. Case 1 was a 66-year-old man. Emergent CAG demonstrated total occlusions of RCA-segment 1 and LCX-segment 13. The patient underwent a direct PTCA of the RCA occlusion and an intracoronary infusion of urokinase. Angiography before discharge revealed a 25% stenosis of the RCA and a 75% stenosis of the LCX. Case 2 was a 68-year-old man. His ECG showed ST elevation in inferior and anterior leads. Emergent CAG demonstrated a 99% stenosis of RCA-segment 1 and total obstruction in LAD-segment 6. The distal LAD was not visualized by antegrade and retrograde flow from collaterals. We considered the state of hyper-coagulability and reducing of coronary blood flow as the mechanism of simultaneous occlusions in our cases.