Karakurt Ozlem, Kiliç Harun, Akdemir Ramazan
Department of Cardiology, Ankara Dişkapi Training and Research Hospital, Ankara, Turkey.
Turk Kardiyol Dern Ars. 2010 Jan;38(1):44-6.
A 68-year-old man with a history of two coronary artery bypass operations was admitted with acute inferior myocardial infarction (AMI) and cardiogenic shock. The electrocardiogram showed ST-segment elevation in leads D2, D3, and aVF. Coronary angiography demonstrated a 75% thrombotic stenosis in the right coronary artery (RCA), 90-99% stenosis in the intermediate coronary artery, and plaques in the circumflex artery. While assessing the patency of bypass grafts, a 99% stenosis was noted in the distal subclavian artery. The culprit artery was deemed to be the RCA, and after direct stenting, TIMI III flow was achieved. Ten days later, stent implantation was performed for the intermediate coronary artery, at which time distal subclavian artery stenosis was not observed. Distal subclavian artery spasm was thought to occur during AMI.
一名有两次冠状动脉搭桥手术史的68岁男性因急性下壁心肌梗死（AMI）和心源性休克入院。心电图显示D2、D3和aVF导联ST段抬高。冠状动脉造影显示右冠状动脉（RCA）有75%的血栓性狭窄，中间冠状动脉有90 - 99%的狭窄，回旋支动脉有斑块。在评估搭桥血管通畅情况时，发现锁骨下动脉远端有99%的狭窄。罪犯血管被认为是RCA，直接支架置入术后实现了TIMI III级血流。10天后，对中间冠状动脉进行了支架植入，此时未观察到锁骨下动脉远端狭窄。认为锁骨下动脉远端痉挛发生在AMI期间。
