Ermis Emrah, Kahraman Serkan, Ucar Hakan, Ozyılmaz Sinem Ozbay, Allahverdiyev Samir
Department of Cardiology, Faculty of Medicine, Biruni University, Istanbul, Turkey.
Department of Cardiology, Silivri State Hospital, Istanbul, Turkey.
Int J Angiol. 2018 Dec;27(4):223-226. doi: 10.1055/s-0037-1608959. Epub 2017 Dec 12.
Simultaneous multivessel epicardial coronary artery thrombosis is an uncommon finding in acute ST-segment elevation myocardial infarction (STEMI). It generally leads to cardiogenic shock and sudden cardiac death in the hospital. We report a 42-year-old male patient presenting with acute anterior STEMI with triple coronary artery thrombosis. An emergency coronary angiogram showed total occlusion of the left anterior descending artery (LAD) with thrombus formation. At the same time, thrombus formations were also seen in the circumflex artery (CXA), the second obtuse marginal (OM2) branch, and the distal right coronary artery (RCA). We unsuccessfully attempted thrombus aspiration of the LAD. Subsequently, we decided to stent the LAD, and a successful percutaneous coronary intervention (PCI) was performed for the LAD. In a second procedure, RCA thrombosis regressed with 24-hour tirofiban (glycoprotein IIb/IIIa receptor inhibitor) perfusion, although CXA thrombosis and OM thrombosis did not regress. Therefore, we performed stenting of the CXA and OM with a newer provisional technique called the flower petal technique. Thrombolysis in myocardial infarction (TIMI) flow grade III was seen after stenting. The patient was discharged from the hospital 5 days after PCI without any symptoms.
同时发生的多支心外膜冠状动脉血栓形成在急性ST段抬高型心肌梗死（STEMI）中是一种罕见的表现。它通常会导致心源性休克和患者在医院内的心源性猝死。我们报告了一名42岁男性患者，其表现为急性前壁STEMI伴三支冠状动脉血栓形成。急诊冠状动脉造影显示左前降支（LAD）完全闭塞并伴有血栓形成。与此同时，在回旋支（CXA）、第二钝缘支（OM2）和右冠状动脉远端（RCA）也可见血栓形成。我们对LAD进行血栓抽吸未成功。随后，我们决定对LAD进行支架置入，并成功地对LAD进行了经皮冠状动脉介入治疗（PCI）。在第二次手术中，RCA血栓在使用替罗非班（糖蛋白IIb/IIIa受体抑制剂）灌注24小时后消退，尽管CXA血栓和OM血栓未消退。因此，我们采用一种名为花瓣技术的更新的临时技术对CXA和OM进行了支架置入。支架置入后可见心肌梗死溶栓（TIMI）血流3级。患者在PCI术后5天出院，无任何症状。
