Author + information
- Yuet-Wong Cheng1
Patient initials or identifier number
Relevant clinical history and physical exam
He was a chronic smoker presented with sudden dizziness followed by witnessed cardiac arrest on an ambulance. He had a return of spontaneous circulation after resuscitation. On arrival to Accident and Emergency Department, He had another cardiac arrest and successfully resuscitated. Total down time was 19 minutes.
Relevant test results prior to catheterization
ECG showed new onset LBBB. He was transferred to catheterization laboratory according to primary PCI protocol.
Relevant catheterization findings
Coronary angiography showed a focal stenosis over mid LAD.
Intracoronary imaging with IVUS and OCT, however, showed that this was a stable plaque with moderate stenosis. Instead of direct stenting, TEE was performed and showed dilated right ventricle with pulmonary hypertension. There was no obvious visible thrombus in main pulmonary artery. Pulmonary angiography showed bilateral pulmonary embolism. Percutaneous pulmonary aspiration embolectomy was performed. He had good neurological recovery after intensive care, therapeutic hypothermia and rehabilitation. He was discharged home with warfarin for his pulmonary embolism and medical therapy for stable coronary artery disease.
In selected cases, utilization of intracoronary imaging can be useful in characterization of coronary plaque. In this particular case, the negative finding save the patient from unnecessary coronary intervention which may entailed a higher bleeding risk due to additional DAPT. It also contributed to reduce the risk of mortality and CTEPH by early intervention to an alternative diagnosis of pulmonary embolism.