EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2012
How should I treat a massive thrombus embolisation in the left coronary artery during chronic total occlusion revascularisation?
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Geraci Salvatore, La Manna Alessio, Tamburino Corrado
Аннотация
BACKGROUND: A 53-year-old man symptomatic for unstable angina, underwent PCI for a severe stenosis of the first obtuse marginal and a CTO of the left circumflex arteries.
INVESTIGATIONS: Physical examination, myocardial necrosis markers, ECG, transthoracic echocardiography, exercise ECG test, bilateral coronary angiography, cardiac magnetic resonance.
DIAGNOSIS: During PCI, antegrade contrast injection displaced a large clot from the guiding catheter into the left coronary artery causing massive thrombosis. The patient became haemodynamically unstable. The pressure wave from the guiding catheter was damped.
MANAGEMENT: Intravenous UFH and abciximab followed by aspiration from the guiding catheter, and then through an aspiration catheter, until clear blood came out and pressure wave was normalised. Subsequent left coronary angiography showed no residual thrombi with TIMI-3 flow. Afterwards, a CMR scan showed no myocardial damage.
INVESTIGATIONS: Physical examination, myocardial necrosis markers, ECG, transthoracic echocardiography, exercise ECG test, bilateral coronary angiography, cardiac magnetic resonance.
DIAGNOSIS: During PCI, antegrade contrast injection displaced a large clot from the guiding catheter into the left coronary artery causing massive thrombosis. The patient became haemodynamically unstable. The pressure wave from the guiding catheter was damped.
MANAGEMENT: Intravenous UFH and abciximab followed by aspiration from the guiding catheter, and then through an aspiration catheter, until clear blood came out and pressure wave was normalised. Subsequent left coronary angiography showed no residual thrombi with TIMI-3 flow. Afterwards, a CMR scan showed no myocardial damage.
Предметные рубрики MeSH
AbciximabAntibodies, MonoclonalAnticoagulantsBiomarkersChronic DiseaseCoronary AngiographyCoronary OcclusionCoronary StenosisCoronary ThrombosisEchocardiographyElectrocardiographyExercise TestHeparinHumansImmunoglobulin Fab FragmentsMagnetic Resonance ImagingMaleMiddle AgedPercutaneous Coronary InterventionPhysical ExaminationPredictive Value of TestsSeverity of Illness IndexSuctionThrombectomyThromboembolismTreatment Outcome