Abubaker Tebianne M, Richardson Karl M, Cox Cody J, Ye Fan
Internal Medicine, Wake Forest School of Medicine, Winston-Salem, USA.
Cardiology, Wake Forest School of Medicine, Winston-Salem, USA.
Cureus. 2022 Dec 9;14(12):e32343. doi: 10.7759/cureus.32343. eCollection 2022 Dec.
Patients who present with acute myocardial infarction are often urgently evaluated for possible revascularization via coronary artery bypass graft surgery (CABG), percutaneous coronary intervention (PCI), or medical therapy alone. CABG has been shown to provide symptomatic relief as well as increased long-term survival for patients with multivessel coronary artery disease (CAD). Though venous grafts can be used to revascularize the ischemic territory, long-term patency is most successful when using pedicled coronary grafts such as the left internal mammary artery (LIMA) or right internal mammary artery (RIMA) graft. Only a fraction of patients who undergo a RIMA or LIMA will occlude their graft, and mid-graft lesions presumed secondary to atherosclerosis are even rare. For our case report, we evaluate a 72-year-old female who has had a very rare acute coronary occlusion of her mid-RIMA graft resulting in an acute apical left ventricular infarct. A heart catheterization confirmed a 100% thrombotic occlusion of the mid-RIMA-LAD, which was stented with a 2.5 x 20 mm drug-eluting stent.
出现急性心肌梗死的患者通常会被紧急评估，以确定是否可以通过冠状动脉旁路移植术（CABG）、经皮冠状动脉介入治疗（PCI）或单纯药物治疗进行血运重建。对于多支冠状动脉疾病（CAD）患者，CABG已被证明能缓解症状并提高长期生存率。虽然静脉移植物可用于为缺血区域进行血运重建，但使用带蒂冠状动脉移植物（如左乳内动脉（LIMA）或右乳内动脉（RIMA）移植物）时，长期通畅率最为理想。接受RIMA或LIMA移植的患者中，只有一小部分会出现移植物闭塞，继发于动脉粥样硬化的移植物中段病变甚至更为罕见。在我们的病例报告中，我们评估了一名72岁女性，她的RIMA移植物中段出现了非常罕见的急性冠状动脉闭塞，导致急性心尖左心室梗死。心脏导管检查证实RIMA-LAD中段出现100%血栓性闭塞，使用2.5×20mm药物洗脱支架进行了支架置入。
