Author + information
- Alexey Biryukov1,
- Kirill Alexeevich Smirnov1,
- Dmitriy Vladimirovich Ovcharenko1,
- Ekaterina Leonidovna Zaslavskaya1 and
- Andrei Aleksandrovich Voronkov1
Patient initials or identifier number
Relevant clinical history and physical exam
Patient U, 58 years admitted to the hospital with chest pain (left side).
Background and Risk factors: CHD. MI 08. 2011, 11. 2011 (anterolateral wall) Arterial Hypertension 3 risk 4.
CHF 2-3 (NYHA) CKD 3bA1, stroke VBB 09.2008. COPD. 30 years of smoking quit in 2008.
Relevant test results prior to catheterization
Patient D, 58 years admitted to the hospital with chest pain (left side) ECG sinus bradycardia 56. PVCs. ST elevation III, avF, depression STI, avL, V2-V6. TnI 0.156 Myoglobin 193.3.
Relevant catheterization findings
Coronary angiography was showed.
Results: Ostial occlusion of LCx. During first contrast media injection, a translocation of thrombus burden from LCx to the middle part of LAD occurred. And the angiographic picture was as follows: Occlusion LAD in the middle part, stenosis 80% of LCx in the proximal part, chronical total occlusion LCx in the middle part. Critical stenosis of RCA in the middle part and CTO distal RCA.
After, recanalization of LAD occlusion with the hydrophilic wire one LAD’s middle part was stented using BMS Multi-link Vision 3.0-23 mm. Next step was stenting of middle and proximal LCx using two BMS Multi-Link Vision 3.5-18 mm.
The patient is transferred to the intensive care unit. Sat 02 71% HR 120, BP 100/70 mm. Endotracheal intubation performed. Mechanical ventilation for 3 days.
The next day after PCI Myoglobin> 4048.0
TnI more than 98, followed by a natural decline.
At 6 days after AMI echocardiography - Akinesia of LV apex, hypokinesia Inferior and side walls of LV.
14 days after AMI-ECG monitoring shows the following: ST depression of 3.8 mm V1-V3 occurred (painless ischemia).
18 days later coronary angiography performed, which revealed 70% stenosis in the proximal part LAD.
PCI of LAD was performed using BMS Multi-link Vision 4.0-15 mm.
According to the control daily monitoring, no ischemic changes detected. The patient was discharged to outpatient treatment.
Conclusion: This case report shows the risk of developing myocardial infarction of another coronary basin due to the thrombus translocation from a primary occluded artery.