Lone aspiration thrombectomy without stenting for a patient with ST-segment elevation myocardial infarction associated w
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CASE REPORT
Lone aspiration thrombectomy without stenting for a patient with ST-segment elevation myocardial infarction associated with coronary ectasia Tetsuro Yokokawa • Yuichi Ujiie • Hironori Kaneko Yoshitane Seino • Mikihiro Kijima • Yasuchika Takeishi
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Received: 24 September 2013 / Accepted: 2 December 2013 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2013
Abstract A 57-year-old male with a previous history of inferior myocardial infarction suffered from chest pain and diagnosed as ST-segment elevation myocardial infarction (STEMI). Coronary angiography revealed a thrombus with delayed filling in the distal right coronary artery. After an aspiration thrombectomy, TIMI 3 flow was restored successfully. An intracoronary ultrasound imaging revealed coronary ectasia. Stenting and ballooning were deferred. A successful lone aspiration thrombectomy was performed for a patient with STEMI associated with coronary ectasia. Keywords Aspiration thrombectomy ST-segment elevation myocardial infarction Coronary ectasia
Introduction Aspiration thrombectomy during percutaneous coronary intervention (PCI) has been recognized as an effective reperfusion therapy for ST-segment elevation myocardial infarction (STEMI) [1, 2]. In recent years, PCI with lone aspiration thrombectomy has been reported to be an effective treatment for selected patients with STEMI [3–7]. However, among STEMI patients, only a few underwent lone aspiration thrombectomy. Here, we report a case of
T. Yokokawa (&) Y. Ujiie H. Kaneko Y. Seino M. Kijima Department of Cardiology, Hoshi General Hospital, 159-1 Mukaibaramachi, Koriyama 963-8501, Japan e-mail: [email protected] Y. Takeishi Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan
STEMI associated with ectasia of right coronary artery, who underwent a successful lone aspiration thrombectomy.
Case report A 51-year-old male, who had cardiovascular risk factors of dyslipidemia and a history of smoking, presented with an inferior myocardial infarction. Percutaneous coronary intervention was performed with a bare metal stent to segment 4AV of the right coronary artery, and a final coronary angiography of the PCI revealed slight coronary dilatation in his right coronary artery (Fig. 1). Clopidogrel and aspirin were administrated. A follow-up coronary angiography was performed at 6 months after the implantation of bare metal stent, which showed no significant stenosis in his right coronary artery. Multi-detector computed tomography taken at 14 months after the implantation revealed coronary ectasia of right coronary artery and suggested presence of mural thrombus in the coronary ectasia (Fig. 2). At 64 months, clopidogrel was discontinued and aspirin was continued. At 65 months, when he was 57 years old, the patient suddenly suffered from precordial chest pain and was admitted to our hospital. Electrocardiogram showed a sinus rhythm and ST-segment elevation in leads II, III and, aVF. The patient was diagnosed as STEMI. Emergenc
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