PMC9036379_01
EKG (Electrocardiogram) with T-wave inversions in inferior leads.
10.1177_23247096221089496-fig1.jpg
PMC9036379_01_10.1177_23247096221089496-fig1.jpg
fig1-23247096221089496
Cardiac angiography and echocardiogram showed an ejection fraction of 70% without significant abnormalities(Figure 1).
Magnetic resonance imaging of the brain revealed an ischemic stroke (restricted diffusion) in the right temporal-parietal junction and insula in middle cerebral artery distribution.
10.1177_23247096221089496-fig2.jpg
PMC9036379_01_10.1177_23247096221089496-fig2.jpg
fig2-23247096221089496
Magnetic resonance imaging of the brain revealed an ischemic stroke (restricted diffusion) in the right temporal-parietal junction and insula in the middle cerebral artery distribution (Figure 2).
Computerized tomography angiography of the head and neck showed right internal carotid artery occlusion.
10.1177_23247096221089496-fig3.jpg
PMC9036379_01_10.1177_23247096221089496-fig3.jpg
fig3-23247096221089496
Computerized tomography angiography (CTA) of the head and neck (Figure 3) showed right internal carotid artery (ICA) occlusion.
Coronary angiogram with dissection of the very distal right coronary artery (arrow) involving the origin of the right-sided posterior descending artery with TIMI-II flow.. Abbreviation: TIMI, thrombolysis in myocardial infarction.
10.1177_23247096221089496-fig4.jpg
PMC9036379_01_10.1177_23247096221089496-fig4.jpg
fig4-23247096221089496
The patient underwent left heart catheterization which revealed dissection of the distal right coronary artery involving the origin of posterior descending artery with thrombolysis in myocardial infarction (TIMI)-II flow (Figure 4).
Coronary angiogram with TIMI-III flow post-intervention.. Abbreviation: TIMI, thrombolysis in myocardial infarction.
10.1177_23247096221089496-fig5.jpg
PMC9036379_01_10.1177_23247096221089496-fig5.jpg
fig5-23247096221089496
As the patient had already been started on aspirin and clopidogrel, intervention was undertaken with aspiration thrombectomy, balloon angioplasty, and subsequent stent placement in the distal right coronary artery into the posterior descending artery with restoration of TIMI-3 flow (Figure 5).
"Flame-shaped" appearance of right ICA consistent with dissection.. Abbreviation: ICA, internal carotid artery.
10.1177_23247096221089496-fig6.jpg
PMC9036379_01_10.1177_23247096221089496-fig6.jpg
fig6-23247096221089496
The occlusion had a tapering, "flame-shaped" appearance, approximately 1 cm distal to the origin of the ICA:consistent with dissection (Figure 6).