Shabbir Muhammad Asim, Jhand Aravdeep, Velagapudi Poonam
Division of Cardiovascular Medicine, University of Nebraska Medical Center, 982265 Nebraska Medical Center, Omaha, NE 68198, USA.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
Eur Heart J Case Rep. 2023 Jul 26;7(7):ytad303. doi: 10.1093/ehjcr/ytad303. eCollection 2023 Jul.
Non-dominant right coronary artery (RCA) occlusion is uncommon and usually affects a small area of the myocardium. Rarely, it can complicate fatal outcomes such as shock, cardiac arrest, bradyarrhythmia, or tachyarrhythmia.
A 50-year-old man with no significant medical history presented with ventricular fibrillation (VF) cardiac arrest. He required prolonged cardiopulmonary resuscitation and multiple defibrillation shocks to achieve return of spontaneous circulation. ST elevation was noted on inferior leads. Due to refractory VF, extracorporeal membrane oxygenation (ECMO) was initiated followed by coronary angiography which demonstrated 100% acute occlusion of proximal RCA (small non-dominant), 90% stenosis of ramus intermedius (RI), and 80% stenosis of obtuse marginal (OM) arteries. Left ventricular ejection fraction was 35%. Percutaneous coronary intervention (PCI) of the RCA was performed with drug eluting stent. He had excellent clinical recovery without any neurological deficits. The ECMO was weaned off and decannulated within three days. Guideline directed medical therapy was administered. He remained hemodynamically stable and underwent staged PCI of RI and OM to achieve complete revascularization.
Non-dominant RCA lesions are usually considered benign. However, when acute RCA occlusion results in cardiac arrest as seen in our patient, prompt revascularization is necessary. Treatment of cardiogenic shock with appropriate pharmacological and mechanical therapies is important, such as ECMO in our patient.
非优势型右冠状动脉（RCA）闭塞并不常见，通常仅累及一小部分心肌。极少数情况下，它会导致诸如休克、心脏骤停、缓慢性心律失常或快速性心律失常等致命后果。
一名50岁男性，无重大病史，出现心室颤动（VF）心脏骤停。他需要长时间的心肺复苏和多次除颤电击才能实现自主循环恢复。下壁导联可见ST段抬高。由于难治性VF，启动了体外膜肺氧合（ECMO），随后进行冠状动脉造影，结果显示近端RCA（非优势小分支）急性闭塞100%，中间支（RI）狭窄90%，钝缘支（OM）动脉狭窄80%。左心室射血分数为35%。对RCA进行了药物洗脱支架的经皮冠状动脉介入治疗（PCI）。他临床恢复良好，无任何神经功能缺损。ECMO在三天内撤离并拔管。给予了指南指导的药物治疗。他血流动力学保持稳定，并接受了RI和OM的分期PCI以实现完全血运重建。
非优势型RCA病变通常被认为是良性的。然而，当急性RCA闭塞导致心脏骤停，如我们的患者所示，及时进行血运重建是必要的。使用适当的药物和机械疗法治疗心源性休克很重要，如我们患者使用的ECMO。
