Kerim ESENBOĞA

TROMBÜS OLDUKÇA BÜYÜKTÜ: ÖNCE ASPİRASYON YAPILMALI MIYDI ?

Akut yaygın anterior miyokard enfarktüsü tanısı konulan 80 yaşında bir kadın hastaya primeranjiyoplasti amacıyla acil koroner anjiyografi yapıldı. Sol ön inen arter (LAD) ostiumda totalokluzyona neden olan oldukça mobil büyük trombüs materyalinin sol ana koroner arter (LMCA)distali ve sirkümfleks (Cx) arterin ostiumuna kadar uzandığı görüldü. LAD osteal bölgeye perkütantranslüminal anjiyoplasti (PTCA) yapıldıktan sonra yapılan kontrol sineanjiografi esnasında büyüktrombus materyalinin koparak klavuz kateterin yanından sistemik dolaşıma embolize olduğunet bir şekilde izlendi. Akabinde LAD osteal bölgeye Szabo tekniği ile bir adet ilaç salınımlıstent implante edildi. Hastada vaka sırası ya da sonrasında şanslı bir şekilde nörolojik bir olayyaşanmadı

There is a Huge Thrombus: Should we have Performed Aspiration First?

An 80-year-old woman with acute anterior myocardial infarction underwent emergency coronary angiography for primary angioplasty. It has been observed that, total occlusion located in the ostium of left anterior descending artery (LAD) due to a large mobile thrombus material extends to the left main coronary artery (LMCA) and osteal part of the circumflex (Cx) artery. After percutaneous transluminal angioplasty (PTCA) was performed, it was clearly observed that a large thrombus material was embolized to systemic circulation during the control cineangiography. Subsequently, a drug-eluting stent was implanted to the LAD osteal region by Szabo technique. Fortunately, any neurological complication was not observed in the patient during or after the procedure.

PDF

___

Seth A. “Once upon a time there was … intracoronary thrombolysis”. Catheter Cardiovasc Interv 2011;78:76-7.
Horimoto M, Takenaka T, Igarashi K, et al. Coronary spasm as a cause of coronary thrombosis and myocardial infarction. Jpn Heart J 1993;34:627-31.
Feit A, Hazday MS, Reddy CV, et al. Bilateral coronary thrombosis in the absence of inducible coronary spasm, thrombocytosis, coagulation abnormalities, or angiographic evidence of coronary artery disease: Previously undescribed method of myocardial infarction. Cathet Cardiovasc Diagn 1988;15:40-3.
Davies MJ. Thrombosis and coronary atherosclerosis. In: Julian DG, Kubler W, Norris RM, Swan HJC, Collen D, Verstraete M, eds. Thrombolysis in Cardiovascular Disease. New York, NY: Marcel Dekker Inc, 1989:25-33.
Patel M, Bhangoo M, Prasad A. Successful percutaneous treatment of suspected embolic left main thrombosis in a patient with a mechanical aortic valve. J Invasive Cardiol 2011;23:E263-6.
Prasad SB, Whitbourn R, Malaiapan Y, Ahmar W, MacIsaac A, Meredith IT. Primary percutaneous coronary intervention for acute myocardial infarction caused by unprotected left main stem thrombosis. Catheter Cardiovasc Interv 2009;73:301-7.
Mabin TA, Holmes DR, Smith HC, et al. Intracoronary thrombus: Role in coronary occlusion complicating percutaneous transluminal coronary angioplasty. J Am Coll Cardiol 1985;5:198-202.
Reffelmann, Kloner RA. The “no-reflow” phenomenon: basic science and clinical correlates. Heart 2002; 87: 162-8.
Monsen CE, Borrico S, Gorlin R, Fuster V. Angiographic demonstration of a common link between unstable angina pectoris and non-Q wave acute myocardial infarction. Am J Cardiol 1988;61:244-7.
Ambrose JA, Winters SL, Stern A, et al. Angiographic morphology and the pathogenesis of unstable angina pectoris. J Am Coll Cardiol 1985;5:609-16.
John AA, Michael W. Thrombosis in ischemic heart disease. Arch Intern Med 1996;156:1382-94.