PMC6481135_01
(a) ECG at admission (I, II, III, aVF, aVL, and aVF). (b) ECG at admission (V1-V6). (c) ECG at admission (right leads).
CRIC2019-7979316.001.jpg
PMC6481135_01_CRIC2019-7979316.001.jpg
fig1
The 12-lead ECG revealed myocardial infarction with ST segment elevation (STEMI) (elevation present in the inferior and V5/V6 leads) (Figures 1(a)-1(c)).
Occlusion of the middle segment of the left circumflex artery (LCx) (image after a partial recanalization with a guidewire).
CRIC2019-7979316.002.jpg
PMC6481135_01_CRIC2019-7979316.002.jpg
fig2
Three drug-eluting stents (DES) were implanted in the LCx, and due to unsatisfactory postprocedural TIMI flow (TIMI I), GP IIb/IIIa inhibitor eptifibatide was applied after the procedure (180 mcg/kg as a IV bolus:15,3 mg, followed by a continuous infusion of 2 mcg/kg/min up to 75 mg of eptifibatide in total) (Figures 2-4).
Left anterior descending artery (LAD) with collaterals to the right coronary artery (RCA).
CRIC2019-7979316.003.jpg
PMC6481135_01_CRIC2019-7979316.003.jpg
fig3
Three drug-eluting stents (DES) were implanted in the LCx, and due to unsatisfactory postprocedural TIMI flow (TIMI I), GP IIb/IIIa inhibitor eptifibatide was applied after the procedure (180 mcg/kg as a IV bolus:15,3 mg, followed by a continuous infusion of 2 mcg/kg/min up to 75 mg of eptifibatide in total) (Figures 2-4).
Chronic total occlusion (CTO) of the proximal right coronary artery (RCA) segment.
CRIC2019-7979316.004.jpg
PMC6481135_01_CRIC2019-7979316.004.jpg
fig4
Three drug-eluting stents (DES) were implanted in the LCx, and due to unsatisfactory postprocedural TIMI flow (TIMI I), GP IIb/IIIa inhibitor eptifibatide was applied after the procedure (180 mcg/kg as a IV bolus:15,3 mg, followed by a continuous infusion of 2 mcg/kg/min up to 75 mg of eptifibatide in total) (Figures 2-4).
In-stent thrombosis of the left circumflex artery (LCx).
CRIC2019-7979316.005.jpg
PMC6481135_01_CRIC2019-7979316.005.jpg
fig5
The second coronary angiography revealed CTO of the RCA and an in-stent thrombosis with occlusion of stents in LCx (Figure 5).
Recanalized right coronary artery (RCA) occlusion.
CRIC2019-7979316.006.jpg
PMC6481135_01_CRIC2019-7979316.006.jpg
fig6
After admission, coronary angiography was performed showing a spontaneous recanalization of the RCA, with a nonsignificant stenosis of the proximal-to-middle RCA segment, a 50% stenosis of the posterior descending artery, and no collaterals from left anterior descending artery (LAD) as well as persistent in-stent occlusion in the LCx with new collaterals from the first marginal artery (Figure 6).