RESUMO
Double-arterial coronary stent thrombosis in acute myocardial infarction (AMI) is an infrequent but severe complication, especially when the third main coronary artery is chronically occluded. The conus artery (CA) can serve as a major source of collateral when the left anterior descendent coronary artery (LAD) becomes obstructed. We report a case of a 48-year-old man presenting with AMI due to a very late double-arterial stent thrombosis (ST) following drug-eluting stent implantation and a chronic occlusion of LAD collateralized by a large anomalous CA, which provided for the entire vascularization of the coronary tree.
Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Oclusão Coronária/complicações , Anomalias dos Vasos Coronários/complicações , Infarto do Miocárdio/etiologia , Trombose/etiologia , Angioplastia Coronária com Balão/instrumentação , Doença Crônica , Circulação Colateral , Circulação Coronária , Oclusão Coronária/fisiopatologia , Oclusão Coronária/terapia , Anomalias dos Vasos Coronários/fisiopatologia , Anomalias dos Vasos Coronários/terapia , Stents Farmacológicos , Fibrinolíticos/uso terapêutico , Humanos , Masculino , Metais , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/terapia , Inibidores da Agregação Plaquetária/uso terapêutico , Desenho de Prótese , Stents , Trombose/fisiopatologia , Resultado do TratamentoRESUMO
An 85-year-old male patient, with long-standing hypertension, was admitted to our hospital for a late inferior myocardial infarction. An elective coronary angiogram was performed, but due to severe iliac artery tortuosity, thoracic aortic dilatation, high left coronary artery take-off, and separated origin of the left descending coronary artery and circumflex, selective cannulation with different catheter shapes was not possible. Thus, we decided to utilize a modified mother-child technique by cutting the first 10 cm from the hub of a conventional 7 F Judkins left 4 guiding catheter and inserting it into a 7 F valved sheath. Then, we introduced a conventional 6 F Amplatz Left 2 diagnostic catheter inside it. In this way, we were able to easily reach both separate ostia and to perform complete left coronary angiography. The technique we described herewith could represent a valid solution to allow utilization of standard coronary catheters with different shapes commercially available in cases of complex coronary artery origin.