Siddiqui Sabah, Ayzenberg Sergey, Morshed Ahmad, Miller Avraham, Malyshev Yury
Cardiology, Maimonides Medical Center, Brooklyn, USA.
Cureus. 2020 Sep 1;12(9):e10181. doi: 10.7759/cureus.10181.
The mortality of patients from a retroperitoneal hematoma remains high if treatment is delayed or inappropriate. Percutaneous endovascular repair of iatrogenic vascular complications is quickly becoming the treatment of choice. Here, we report a case of a 76-year-old female with a non-ST-elevation myocardial infarction, whose cardiac catheterization revealed a 70% distal left main coronary artery (LMCA) stenosis. She underwent successful rotational atherectomy and deployment of drug-eluting stents of the distal LMCA. Following percutaneous coronary intervention, she suffered acute profound hypotension and was found to have a retroperitoneal hematoma. Given the high cardiac risk for vascular surgery due to recent intervention and overall comorbidities, she was immediately taken to the cardiac catheterization laboratory and had a diagnostic angiogram, which revealed a right external iliac artery perforation that was treated with a covered stent. She tolerated the procedure well. This case highlights the importance of early diagnosis of retroperitoneal bleed, the prompt decision to take the patient to the cardiac catheterization laboratory, and potential use of intravascular interventions to ensure a successful outcome.
如果治疗延迟或不当，腹膜后血肿患者的死亡率仍然很高。经皮血管腔内修复医源性血管并发症正迅速成为首选治疗方法。在此，我们报告一例76岁女性非ST段抬高型心肌梗死患者，其心脏导管检查显示左冠状动脉主干（LMCA）远端狭窄70%。她成功接受了旋磨术并在LMCA远端植入药物洗脱支架。经皮冠状动脉介入治疗后，她出现急性严重低血压，被发现有腹膜后血肿。鉴于近期介入治疗和总体合并症导致血管手术的心脏风险很高，她立即被送往心脏导管室并进行了诊断性血管造影，结果显示右髂外动脉穿孔，使用覆膜支架进行了治疗。她对该手术耐受性良好。该病例强调了早期诊断腹膜后出血的重要性、迅速决定将患者送往心脏导管室的必要性以及血管内干预措施确保成功治疗结果的潜在作用。
