Nusret AÇIKGÖZ, Yılmaz OTLU ÖMÜR, Zeynep ULUTAŞ, Abdulmecit AFŞİN, Mahmut YILMAZ

Multivessel Coronary Artery Thrombosis Accompanying Acute Myocardial Infarction: A Case Report

Akut ST segment elevasyonlu miyokard enfarktüsü (STEMI) ile eş zamanlı çoklu koroner arter trombozisi nadir görülen durumdur ve kötüprognoz ile ilişkilidir. 63 yaşındaki erkek hasta 3 saat önce başlayan ani göğüs ağrısı şikayetiyle acil servise başvurdu. Hastaya akut inferiorSTEMI tanısı konuldu. Yapılan acil koroner anjiografi de sol ön inen (LAD), sol sirkümfleks (LCx) ve sol sirkümfleks arterin ilk dalı (obtüsmarjin) arterde akut tromboz saptandı. Obtüs marjin lezyonuna stent uygulandı, LAD ve LCx deki trombüs için tirofiban (glikoprotein 2b/3ainhibitörü) infüzyonu kararı verildi. Tirofiban infüzyonu sonrası yapılan koroner anjiografide koroner arterlerde trombüs izlenmedi. Hastakomplikasyonsuz taburcu edildi.

Akut Miyokard Enfarktüsü Geçiren Bir Hastada Multi Koroner Arter Trombozu

Acute ST-segment elevation myocardial infarction (STEMI) complicated with multiple coronary artery thrombosis is a rare clinical situatio and is associated with poor prognosis. A 63-year-old male patient was admitted to the emergency department with sudden chest pain tha had started three hours ago. The patient was diagnosed with acute inferior STEMI. The emergency coronary angiography showed acut arterial thrombosis in the left anterior descending (LAD), left circumflex (LCx), and the left first branch of the circumflex artery (obtus margin). Obtuse margin of the lesion was treated with a stent. We decided to infuse tirofiban (glycoprotein 2b/3a inhibition) for th thrombosis in the LAD and CX vessels. After the tirofiban infusion, the coronary angiography showed no thrombi in the coronary arteries The patient was discharged without further complications.

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1. Kanei Y, Janardhanan R, Fox JT, Gowda RM. Multivessel Coronary Artery Trombosis. Literature Rewiev J Invasive Cardiol 2009;21(3):66-8.
2. Gan F, Hu D, Dai D. Acute multivessel coronery artery occlusion. A case report. BMC Resarch Notes 2012;5:523.
3. Turgeman Y, Suleiman L, Atar S. Multivessel acute coronary thrombosis and occlusion-An unusual cause of cardiogenic shock. J Invasive Cardiol 2007;19:E278-E280.
4. Rioufol G, Finet G, Ginon I, et al. Multiple atherosclerotic plaque rupture in acute coronary syndrome. A three-vessel intravascular ultrasound study. Circulation 2002;106:804-8.
5. Echavarria-Pinto M, Loges R, Gorqadze T, Gonzalo N, Hemendez R, Jimenez Quevedo P, et al. Safety and Efficacy of Intense Antithrombotic Treatment and Percutaneous Coronary Intervention Deferral in Patients With Large Intracoronary Thrombus. Am J Cardiol 2013;111(12):1745- 50.
6. Maseri A, L'ahhate A, Chierchia S, Parodi O, Severi DC, Sevcri S, et al. Significance of spasm in the pathogenesis of ischemic heart disease. Am J Cardiol 1979;44:788-79.