Myocardial infarction caused by coronary artery dissection due to blunt injury: is thromboaspiration an appropriate treatment?

The present study reports a case of myocardial infarction (MI) resulting from blunt trauma-induced coronary artery injury. After falling from a 5-meter-tall building, a man suffered multiple fractures of the arms and legs. Percutaneous coronary intervention (PCI) was performed 48 hours after successful repair of the limb fractures. Coronary angiography revealed an occlusion of the left anterior descending artery, without significant lesions of other arteries. Intravascular ultrasound showed obvious signs of coronary artery dissection at the calcium point of the intimal layer, intramural hematoma, and intimal stripping. The intimal lesion itself may have been responsible for the MI, by causing mechanical obstruction. Use of a thrombectomy device to remove the thrombus caused coronary artery spasm and no blood flow. Sodium nitroprusside and tirofiban were injected into the coronary artery three times, and the coronary blood flow was restored. The patient was again returned to the care unit. One week later, balloon angioplasty without thromboaspiration was performed, and a rapamycin-eluting stent was placed at the point of the intimal lesion. The patient was discharged uneventfully 7 days after stent placement. The patient was asymptomatic and doing well at the outpatient follow-up visit 1 year after PCI.