Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2013 Jul;76(7):407-10. doi: 10.1016/j.jcma.2013.03.007. Epub 2013 May 9.
Simultaneous thrombosis of more than one coronary artery is an uncommon angiographic finding in acute ST-segment elevation myocardial infarction (STEMI), and usually leads to cardiogenic shock or even sudden cardiac death. We reported a 56-year-old man presenting with persistent chest tightness and ST-segment elevation over precordial leads in electrocardiography (ECG). Emergent coronary angiogram showed total occlusion of both the proximal right coronary artery (RCA) and the proximal left anterior descending artery (LAD). We performed thrombus aspiration and stenting over the LAD with thrombolysis in myocardial infarction (TIMI) III flow to the distal LAD. However, diminishing collateral flow to the distal RCA complicated with complete atrioventricular block (CAVB) and cardiogenic shock developed thereafter. Because distal embolization of the collateral circulation from the LAD to the distal RCA was suspected, thrombus aspiration and stenting over the proximal RCA were performed. After reperfusion of the RCA, the patient's hemodynamic status stabilized and he recovered uneventfully.
多支冠状动脉同时血栓形成在急性 ST 段抬高型心肌梗死（STEMI）中是一种不常见的血管造影表现，通常导致心源性休克甚至心脏性猝死。我们报告了 1 例 56 岁男性，表现为持续胸闷和心电图（ECG）胸前导联 ST 段抬高。紧急冠状动脉造影显示右冠状动脉（RCA）近端和左前降支（LAD）近端完全闭塞。我们对 LAD 进行血栓抽吸和支架置入，使 LAD 血流达到心肌梗死溶栓治疗（TIMI）III 级。然而，随后向 RCA 远端的侧支循环的侧支血流减少，并发完全性房室传导阻滞（CAVB）和心源性休克。由于怀疑 LAD 侧支循环向 RCA 远端的远端栓塞，对 RCA 近端进行血栓抽吸和支架置入。RCA 再灌注后，患者血流动力学状态稳定，恢复顺利。
