Contrast media injection into right coronary artery caused thrombus extraction to aorta that may have resulted in left m
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CASE REPORT
Contrast media injection into right coronary artery caused thrombus extraction to aorta that may have resulted in left main trunk thrombosis Atsushi Ikeda • Masayuki Inagaki • Shigeru Fukuzawa • Juji Sugioka • Shinichi Okino • Junpei Maekawa • Sachiko Maekawa • Soichiro Ichikawa Takashi Uchiyama • Norihiko Kamioka • Nobuyuki Kuroiwa
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Received: 12 October 2010 / Accepted: 1 August 2011 / Published online: 3 December 2011 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2011
Abstract A 59-year-old man with inferior acute myocardial infarction underwent an urgent coronary angiography and as a result a total occlusion of the ostial right coronary artery (RCA) was observed. Interestingly, the thrombus in the RCA clearly shortened within 2.3 s during the contrast media injection. While we prepared for percutaneous coronary intervention (PCI) of the RCA, ventricular fibrillation occurred and pulseless electrical activity continued in spite of repeated cardioversion. Despite no stenosis in the left main trunk (LMT) in the initial coronary angiography, the LMT was totally occluded. Following aspiration therapy on the LMT with percutaneous cardiopulmonary support, PCI of the RCA was performed. A coronary angiography should be carefully performed if a lot of thrombi exist in the coronary ostium because LMT embolism may have been caused by thrombus extraction from the RCA by contrast media injection. Keywords Percutaneous coronary intervention LMT thrombosis Global ischemia
Electronic supplementary material The online version of this article (doi:10.1007/s12928-011-0082-z) contains supplementary material, which is available to authorized users. A. Ikeda (&) M. Inagaki S. Fukuzawa J. Sugioka S. Okino J. Maekawa S. Maekawa S. Ichikawa T. Uchiyama N. Kamioka N. Kuroiwa Division of Cardiology, Heart and Vascular Institute, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi 273-8588, Chiba, Japan e-mail: [email protected]
Introduction Percutaneous coronary intervention (PCI) has been well established as a reperfusion therapy for patients with acute myocardial infarction (AMI). Distal embolism or no/slow flow by thrombus isolation from a culprit lesion is well known as a complication at the time of PCI for patients with AMI. Furthermore thromboembolism by an intraventricular or atrial thrombus is also well known as a cause of AMI [1]. However, it has seldom been reported so far that thrombus extraction from a culprit lesion of AMI by means of contrast media injection during a coronary angiography (CAG) might caused coronary artery thrombosis on the other side.
Case report A 59-year-old man visited a local clinic at 9.00 a.m. on March 12, 2009 with severe chest pain. He had had the chest pain for a few days. An electrocardiogram (ECG) was performed on him and it demonstrated ST-T changes. Therefore, he was subsequently transferred to our hospital for closer examination and medical treatment. His blood pressure was 190/108 mmHg and his pulse rate was 110/m
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