Abstract
Case report of the male with an anterior STEMI to whom a primary PCI is performed. The angiogram shows a fluctuating close of the LAD and Cx than when an OCT is performed does not clearly see any pathological findings but when the IVUS is performed, it is clearly seen as a coronary haematoma at the LM, LAD and Cx. Stent at the LM-LAD and proximal Cx are implanted with final good result. After exchanging the guiding catheter for a diagnostic catheter to visualize the RCA, there is an aortic flap; the coronary haematoma was coming from an ascending aortic dissection. The CT confirms the type A aortic dissection and the patient is sent to urgent surgery where it seems that the point of intimal disruption is close to brachiocephalic trunk; a supracommissural ascending aortic replacement is performed. After several complications the patient did well and he is alive. Although the patient got the right approach, as we focused on the coronary arteries we did not realized there was an aortic dissection until the end of the procedure.
Highlights
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Male with an anterior STEMI; the angiogram shows a fluctuating close of LAD and Cx.
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No pathological findings at OCT, but the IVUS shows a hematoma at LM, LAD and Cx.
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Stents at the LM–LAD and proximal Cx are implanted with final good result.
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After exchanging the guiding catheter to visualize the RCA, there is an aortic flap.
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The patient is sent for a supracommissural ascending aortic replacement.
We report a case of a 67 year-old male, history of hypertension (20years) with good controls. While he is playing golf, he begins with chest pain and dizziness. The ambulance takes him to the ER. ECG shows S-T elevation from V1 to V5 ( Fig. 1 ). BP 70/40. He gets ASA and Ticagrelor and is sent to cath lab for primary PCI. Symptoms-ECG 75 min. Symptoms-cath lab 105 min.
He comes into the hospital with an anterior STEMI and cardiogenic shock; a primary PCI via radial approach is performed and the angiogram shows an occlusion of the LAD ( Fig. 2 ), that recovers flow TIMI 2 after advancing the wire.
Thrombectomy is performed; although no thrombus is seen in the net after flushing the thrombectomy catheter and syringe, there is almost no residual stenosis in the angiogram ( Figs. 3 and 4 ).
