Internal Medicine, Albany Medical Center, Albany, NY 12203, USA.
J Cardiol. 2009 Dec;54(3):503-6. doi: 10.1016/j.jjcc.2009.03.010. Epub 2009 May 9.
A 58-year-old male presented with severe substernal chest pain along with bilateral lower extremity pain. He was tachycardic, tachypneic, and hypoxic with tender right calf. Electrocardiogram showed ST elevation in anterior-lateral leads. Emergency coronary angiography revealed widely patent proximal left anterior descending (LAD) artery and total distal occlusion with an abrupt cut-off. The remaining coronary arteries did not have significant disease. An Export aspiration catheter was used and thrombus was aspirated from the LAD with return of TIMI flow grade 3 and normalization of the ST elevations. Doppler ultrasound revealed deep vein thrombosis; transthoracic echocardiogram using agitated saline echocontrast showed a patent foramen ovale. Nearly 5% of patients with ST elevation myocardial infarction do not have demonstrable atherosclerosis by coronary angiography; paradoxical coronary embolism is among the leading causes in such cases. Paradoxical embolism to the coronary tree is under diagnosed and its antemortem diagnosis is difficult. Information regarding appropriate management of myocardial infarction due to coronary embolism is scant. Aspiration of intracoronary thrombus provides good clinical results, avoiding clot fragmentation and balloon injury associated with angioplasty. We present a rare case of antemortem diagnosis of paradoxical embolism to the coronary artery successfully treated with aspiration alone.
一位 58 岁男性主诉胸骨后剧烈胸痛，伴双侧下肢疼痛。他心动过速、呼吸急促且缺氧，右侧小腿触痛。心电图显示前外侧导联 ST 段抬高。紧急冠状动脉造影显示左前降支（LAD）近端广泛通畅，远段完全闭塞伴突然截断。其余冠状动脉无明显病变。使用 Export 抽吸导管抽吸 LAD 内血栓，血流恢复 TIMI 3 级，ST 段抬高恢复正常。多普勒超声显示深静脉血栓形成；经胸超声心动图使用搅动盐水超声造影显示卵圆孔未闭。约 5%的 ST 段抬高型心肌梗死患者的冠状动脉造影未发现明显动脉粥样硬化；矛盾性冠状动脉栓塞是此类病例的主要原因之一。矛盾性冠状动脉栓塞诊断不足，生前诊断困难。关于由于冠状动脉栓塞引起的心肌梗死的适当治疗的信息很少。冠状动脉内血栓抽吸可提供良好的临床效果，避免与血管成形术相关的血栓碎裂和球囊损伤。我们报告了一例罕见的生前诊断的冠状动脉矛盾性栓塞成功地仅用抽吸治疗的病例。
