Ma Jeffrey, Gustafson Gregory M, Dai Xuming
Division of Cardiology, Theresa and Eugene M. Lang Center for Research and Education, New York Presbyterian - Queens Hospital, Flushing, NY 11355, United States.
World J Cardiol. 2020 Feb 26;12(2):91-96. doi: 10.4330/wjc.v12.i2.91.
Myocardial bridging (MB) is increasingly recognized to stimulate atherogenesis, which may contribute to an acute coronary syndrome. Stenting the coronary segment with MB has been recognized to have an increased risk of in-stent restenosis, stent fracture and coronary perforation. The safety and efficacy of stenting the culprit lesion with overlaying MB in ST elevation myocardial infarction (STEMI) as primary reperfusion therapy has not been established.
We reported a patient who presented with inferior STEMI with a culprit lesion of an acute thrombotic occlusion in the right coronary artery and thrombolysis and thrombin inhibition in myocardial infarction 0 flow. After the stent placement during primary percutaneous coronary intervention, intravascular ultrasound revealed MB overlying the stented segment where heavy atherosclerotic plaque were present. Likely due to the combination of plaque herniation or prolapse caused by MB, as well as local increased inflammation and thrombogenicity, acute stent thrombosis occurred at this region, which led to acute stent failure. The patient required an emergent repeated cardiac catheterization and placing a second layer of stent to enhance the radial strength and reduce the inter-strut space.
Plaque herniation or prolapse after stenting a MB segment in STEMI is a potential etiology for acute stent failure.
心肌桥（MB）越来越被认为会促进动脉粥样硬化形成，这可能导致急性冠状动脉综合征。对存在心肌桥的冠状动脉节段进行支架植入已被认为有支架内再狭窄、支架断裂和冠状动脉穿孔风险增加的情况。在ST段抬高型心肌梗死（STEMI）中，对覆盖心肌桥的罪犯病变进行支架植入作为主要再灌注治疗的安全性和有效性尚未确立。
我们报告了一名患者，其表现为下壁STEMI，罪犯病变为右冠状动脉急性血栓闭塞，心肌梗死0级血流时进行了溶栓和凝血酶抑制治疗。在直接经皮冠状动脉介入治疗期间放置支架后，血管内超声显示支架段上方存在心肌桥，且有重度动脉粥样硬化斑块。可能由于心肌桥导致的斑块疝出或脱垂，以及局部炎症和血栓形成增加的共同作用，该区域发生了急性支架血栓形成，导致急性支架失败。患者需要紧急再次进行心脏导管插入术并放置第二层支架以增强径向强度并减小支架间隙。
STEMI中对心肌桥段进行支架植入后斑块疝出或脱垂是急性支架失败的潜在病因。
