PMC9842189_01
EKG from presentation. ST elevations in leads II, III, and aVF (2 mm in leads II and III; 1.5 mm in aVF) with ST depressions in aVL and leads V2-V5 (avL: 1.5 mm, V2: 2 mm, V3: 2.5 mm, V4: 1.5 mm, and V5: 1 mm), consistent with acute inferoposterior ST-elevation myocardial infarction (STEMI).
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FIG1
Initial electrocardiogram (EKG) showed ST-elevations in leads II, III, and aVF, with ST-depressions in aVL and leads V2-V5 (Figure 1), consistent with acute inferoposterior ST-elevation myocardial infarction (STEMI), requiring emergent cardiac catheterization.
First angiogram. (A) Pre-intervention, showing 100% distal occlusion of the right coronary artery (RCA) (LAO 26 /CRAN 0 ). (B) Pre-intervention, showing 100% distal occlusion of the RCA with wire through lesion (LAO 26 /CRAN 18 ). (C) Following drug-eluting stent (DES) placement (LAO 26 /CRAN 18 ).. LAO: left anterior oblique; CRAN: cranial.
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FIG2
Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow (Figures 2, 3). The procedure was completed without complications, with the exception of two episodes of non-sustained ventricular tachycardia, managed with an amiodarone drip.
Illustration of the first angiogram. RCA: right coronary artery; LAD: left anterior descending artery; LCx: left circumflex artery; TIMI: Thrombolysis in Myocardial Infarction; SCA: subclavian artery; IMA: internal mammary artery; CCA: common carotid artery; RPL: right posterolateral artery; RPDA: posterior descending coronary artery; AAo: ascending aorta; DAo: descending aorta; S (S1, S2, S3, S4): septal arteries; D (D1, D2, D3): diagonal arteries; OM (OM1, OM2, OM3): obtuse marginal artery; RM (RM1, RM2): ramus artery.
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FIG3
Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow (Figures 2, 3). The procedure was completed without complications, with the exception of two episodes of non-sustained ventricular tachycardia, managed with an amiodarone drip.
EKG post-percutaneous coronary intervention. Inferolateral ST elevations and new ST elevations in anteroapical leads (3.5 mm in aVF and 1.5-2.5 mm in V4-V6).
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FIG4
LHC after RCA stent thrombosis. (A) Pre-intervention (LAO 24 /CRAN 0 ). (B) Pre-intervention: wire crossing the lesion helped to break up the thrombus and restore some blood flow (LAO 24 /CRAN 17 ). (C) Pre-intervention: balloon placement (LAO 24 /CRAN 17 ). (D) Post-balloon inflation (LAO 24 /CRAN 17 ).. LHC: left heart catheterization; RCA: right coronary artery; LAO: left anterior oblique; CRAN: cranial.
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FIG5
Given his age and acuity of symptoms in the setting of worsening EKG, a repeat angiogram (Figures 5, 6) was obtained to ensure patency of the stent, which revealed a thrombotic stent occlusion of the RCA requiring mechanical thrombectomy and re-stenting.
Illustration of repeat angiogram after thrombosis. RCA showed distal vessel occlusion with 0% residual stenosis post re-stenting.. RCA: right coronary artery; LAD: left anterior descending artery; LCx: left circumflex artery; TIMI: Thrombolysis in Myocardial Infarction; SCA: subclavian artery; IMA: internal mammary artery; CCA: common carotid artery; RPL: right posterolateral artery; RPDA: posterior descending coronary artery; AAo: ascending aorta; DAo: descending aorta; S (S1, S2, S3, S4): septal arteries; D (D1, D2, D3): diagonal arteries; OM (OM1, OM2, OM3): obtuse marginal artery; RM (RM1, RM2): ramus artery.
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FIG6
Given his age and acuity of symptoms in the setting of worsening EKG, a repeat angiogram (Figures 5, 6) was obtained to ensure patency of the stent, which revealed a thrombotic stent occlusion of the RCA requiring mechanical thrombectomy and re-stenting.