Sabol Pušić Mateja, Ostrički Branko, Kovačić Mihajlo
Cardiology with coronary care unit, County hospital Čakovec, Čakovec, Croatia.
Acta Clin Croat. 2024 Mar;63(Suppl1):81-85. doi: 10.20471/acc.2024.63.s1.15.
A 74-year-old patient was hospitalized because of pulmonary embolism and deep venous thrombosis. Standard medication therapy was administered but the inferolateral ST elevation myocardial infarction (STEMI) occurred only a few hours after the admission. Coronary angiography was performed, and circumflex artery (ACx) occlusion verified. Initially, thromboaspiration was done, the lesion was predilated with a semi-compliant (SC) balloon and drug eluting stent (DES) was placed. The control angiogram showed a filling defect at the occlusion site, while the expanded stent was visualized in the left main (it did not adequately detach during inflation and was pulled retrograde to the guide catheter). We attempted to remove the stent by passing an SC balloon over the stent and it was pulled under fluoroscopic guidance to the brachial artery. An effort was then made to extract the stent using ˝twisting guide wire technique˝, but without success. Finally, the stent was grasped with an EN Snare® device and removed completely through the sheath. The procedure ended with the repositioning of the guide catheter and implantation of a new stent. In further hospitalization, gastroenterological workup was planned, but because of septic shock and COVID infection, the patient died due to multiorgan failure.
一名74岁患者因肺栓塞和深静脉血栓形成入院。给予标准药物治疗，但入院仅数小时后就发生了下壁ST段抬高型心肌梗死（STEMI）。进行了冠状动脉造影，证实回旋支动脉（ACx）闭塞。最初，进行了血栓抽吸，用半顺应性（SC）球囊对病变进行预扩张，并置入药物洗脱支架（DES）。对照血管造影显示闭塞部位有充盈缺损，而扩张后的支架在左主干中显影（其在膨胀过程中未充分脱离，被逆行拉回引导导管）。我们试图通过将一个SC球囊穿过支架来取出支架，并在透视引导下将其拉至肱动脉。然后尝试使用“扭转导丝技术”取出支架，但未成功。最后，用EN Snare®装置抓住支架并通过鞘管完全取出。手术最后重新放置引导导管并植入了一枚新支架。在进一步住院期间，计划进行胃肠病学检查，但由于感染性休克和新冠感染，患者因多器官衰竭死亡。
