PMC9663457_01
(A) On admission, ECG showed atrial fibrillation and ST-segment elevation in the anterior wall leads. (B) Coronary angiography showed occlusion of the left circumflex artery. (C) Blood flow was restored after coronary stent implantation. (D) Brain computed tomography showed no hemorrhage before intravenous thrombolytic therapy.
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F1
Emergency ECG showed AF, significant ST-T abnormality (Figure 1A). AMI was diagnosed, and emergency coronary angiography (CAG) was performed to show diffuse plaque formation of right coronary artery (RCA), with 70% proximal stenosis, 90% middle stenosis, normal left main artery, 80% stenosis in the middle of left anterior descending artery (LAD), and 100% occlusion in the middle of left circumflex artery (LCX) (Figure 1B). LCX was considered as the culprit vessel, and finally a drug-eluting stent was implanted for LCX with Thrombolysis in myocardial infarction (TIMI) grade flow of 3 (Figure 1C). Emergency computed tomography angiography (CTA) of cerebral artery showed no obvious large vessel stenosis, no intracerebral hemorrhage (Figure 1D).
PMC9663457_02
(A) Brain computed tomography angiography showed no hemorrhage before intravenous thrombolytic therapy, and showed weak imaging of bilateral anterior cerebral arteries. (B) ECG showed ST-segment elevation in the lower wall lead. (C) Coronary angiography showed 95% stenosis of the distal right coronary with thrombosis. (D) One drug-eluting stent was implanted in the right coronary artery.
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F2
Cranial vascular CTA showed weak imaging of bilateral anterior cerebral arteries (Figure 2A). Forty five minutes later, electrocardiograph monitor showed heart rate of 40 beats/min, BP 70/40 mmHg and ECG showed ST segment elevation of inferior wall leads (Figure 2B). CAG showed 70% stenosis in the proximal segment of LAD, 80% stenosis in the proximal segment of LCX, 40% stenosis in the proximal segment of RCA, and 95% stenosis in the distal segment of RCA showing thrombus shadow (Figure 2C). Considering the culprit vessel was the RCA, thrombus aspiration was performed, and a drug-eluting stent was implanted, with TIMI grade flow of 3 (Figure 2D).