Int J Angiol 2018; 27(04): 223-226
DOI: 10.1055/s-0037-1608959
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Triple Coronary Artery Thrombosis Presenting as Acute Anterior ST-Segment Elevation Myocardial Infarction

Emrah Ermis
1   Department of Cardiology, Faculty of Medicine, Biruni University, Istanbul, Turkey
,
Serkan Kahraman
2   Department of Cardiology, Silivri State Hospital, Istanbul, Turkey
,
Hakan Ucar
1   Department of Cardiology, Faculty of Medicine, Biruni University, Istanbul, Turkey
,
Sinem Ozbay Ozyılmaz
1   Department of Cardiology, Faculty of Medicine, Biruni University, Istanbul, Turkey
,
Samir Allahverdiyev
1   Department of Cardiology, Faculty of Medicine, Biruni University, Istanbul, Turkey
› Author Affiliations
Further Information

Publication History

Publication Date:
12 December 2017 (online)

Abstract

Simultaneous multivessel epicardial coronary artery thrombosis is an uncommon finding in acute ST-segment elevation myocardial infarction (STEMI). It generally leads to cardiogenic shock and sudden cardiac death in the hospital. We report a 42-year-old male patient presenting with acute anterior STEMI with triple coronary artery thrombosis. An emergency coronary angiogram showed total occlusion of the left anterior descending artery (LAD) with thrombus formation. At the same time, thrombus formations were also seen in the circumflex artery (CXA), the second obtuse marginal (OM2) branch, and the distal right coronary artery (RCA). We unsuccessfully attempted thrombus aspiration of the LAD. Subsequently, we decided to stent the LAD, and a successful percutaneous coronary intervention (PCI) was performed for the LAD. In a second procedure, RCA thrombosis regressed with 24-hour tirofiban (glycoprotein IIb/IIIa receptor inhibitor) perfusion, although CXA thrombosis and OM thrombosis did not regress. Therefore, we performed stenting of the CXA and OM with a newer provisional technique called the flower petal technique. Thrombolysis in myocardial infarction (TIMI) flow grade III was seen after stenting. The patient was discharged from the hospital 5 days after PCI without any symptoms.

 
  • References

  • 1 Sorajja P, Gersh BJ, Cox DA. , et al. Impact of multivessel disease on reperfusion success and clinical outcomes in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Eur Heart J 2007; 28 (14) 1709-1716
  • 2 Webb JG, Lowe AM, Sanborn TA. , et al; SHOCK Investigators. Percutaneous coronary intervention for cardiogenic shock in the SHOCK trial. J Am Coll Cardiol 2003; 42 (08) 1380-1386
  • 3 Pollak PM, Parikh SV, Kizilgul M, Keeley EC. Multiple culprit arteries in patients with ST segment elevation myocardial infarction referred for primary percutaneous coronary intervention. Am J Cardiol 2009; 104 (05) 619-623
  • 4 Al Suwaidi J, Al-Qahtani A. Multiple coronary artery thrombosis in a 41-year-old male patient presenting with ST-segment elevation myocardial infarction. J Invasive Cardiol 2012; 24 (03) E43-E46
  • 5 Lee CW, Lai CH, Lu TM. Double coronary artery thrombosis presenting as acute extensive anterior ST-segment elevation myocardial infarction. J Chin Med Assoc 2013; 76 (07) 407-410
  • 6 Biondi-Zoccai G, Lotrionte M, Sheiban I. Management of multivessel coronary disease after ST-elevation myocardial infarction treated by primary coronary angioplasty. Am Heart J 2010; 160 (6, Suppl): S28-S35
  • 7 Kanei Y, Janardhanan R, Fox JT, Gowda RM. Multivessel coronary artery thrombosis. J Invasive Cardiol 2009; 21 (02) 66-68
  • 8 Asakura M, Ueda Y, Yamaguchi O. , et al. Extensive development of vulnerable plaques as a pan-coronary process in patients with myocardial infarction: an angioscopic study. J Am Coll Cardiol 2001; 37 (05) 1284-1288
  • 9 Goldstein JA, Demetriou D, Grines CL, Pica M, Shoukfeh M, O'Neill WW. Multiple complex coronary plaques in patients with acute myocardial infarction. N Engl J Med 2000; 343 (13) 915-922
  • 10 Arbustini E, Dal Bello B, Morbini P. , et al. Plaque erosion is a major substrate for coronary thrombosis in acute myocardial infarction. Heart 1999; 82 (03) 269-272