Acute aortic occlusion evoked by plaque rupture
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IMAGES IN CARDIOVASCULAR INTERVENTION
Acute aortic occlusion evoked by plaque rupture Amane Kozuki1 · Yoichi Kijima1 · Ryoji Nagoshi1 · Hiroyuki Shibata1 · Masahiro Shimizu1 · Junya Shite1 Received: 6 August 2020 / Accepted: 16 September 2020 © Japanese Association of Cardiovascular Intervention and Therapeutics 2020
Keywords Acute aortic occlusion · Plaque rupture · Intravascular ultrasound An atherosclerotic plaque disruption with formation of an occlusive thrombus is a common mechanism for acute myocardial infarctions, while the main mechanisms for acute aortic occlusions are embolisms obstructing the aortic bifurcation or thromboses from existing aortoiliac occlusive disease. A 71-year-old male with a history of peripheral artery disease, coronary artery disease, hypertension, and dyslipidemia presented to the emergency department with sudden onset of resting pain in both legs. Medication provided at onset was aspirin 100 mg, rosuvastatin 15 mg, and ezetimibe 10 mg. The patient had undergone a computed tomography angiography 4 months previously for left leg claudication (Fig. 1a). Severe stenosis of the left common iliac artery was detected. Axial image at red arrow in Fig. 1a revealed mild plaque of low CT number and ulceration at the aorta (Fig. 1b). Implantation of a self-expanding stent via the right distal radial artery was successfully conducted 3 months previously, and the claudication was resolved after this intervention. The cross-sectional intravascular ultrasound image of aorta showed fibrous plaque with spotty calcification (Fig. 1c). The absence of iatrogenic damage was confirmed by angiography performed at the end of the procedure. Both femoral arteries were not palpable. Computed tomography angiography revealed sub-occlusion of the abdominal aorta (Fig. 1d). Emergent endovascular treatment was performed via both common femoral arteries. A clot obtained from the culprit site via a manual thrombectomy showed lipid-rich plaque strongly bonded with a red thrombus (Fig. 1e). Intravascular ultrasound imaging revealed an attenuated plaque with a cavity behind it (Fig. 1f). These findings indicated that the acute aortic occlusion was caused
by rupturing of a lipid-rich moderate plaque with occlusive thrombus formation. Endovascular treatment was successfully performed by implanting two Viabahn balloon-expandable (VBX) stent-grafts (Gore & Associates Inc., Flagstaff, AZ, USA) (Fig. 1g). The symptoms resolved immediately after the procedure, and the patient was discharged 2 days after treatment.
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* Amane Kozuki [email protected] 1
Division of Cardiology, Osaka Saiseikai Nakatsu Hospital, 2‑10‑39, Sibata, Kita‑ku, Osaka‑city, Osaka 530‑0012, Japan
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Fig. 1 a Computed tomography angiography maximum intensity projection image with
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