PMC8384542_01
Inferolateral STEMI. ECG in the ED showing sinus tachycardia and ST-segment elevation in the inferolateral leads.
CRIC2021-5598524.001.jpg
PMC8384542_01_CRIC2021-5598524.001.jpg
fig1
AMI with ST elevations in the inferior and lateral leads (Figure 1). A bedside TTE demonstrated normal left ventricular ejection fraction, mild inferolateral hypokinesis, and absence of tamponade physiology.
Coronary angiography prior to intervention. (a) pRCA, rPL, and PDA thrombus: coronary angiography (LAO view) showing thrombus in the proximal right coronary artery (pRCA), the right posterolateral (rPL), and the right posterior descending (PDA) branches (white arrows). (b) pRCA and rPL thrombus: coronary angiography (RAO view) showing thrombi in the pRCA and rPL branches (white arrows). (c) Normal left main, LAD, and LCX: coronary angiography (LAO cranial view) showing angiographically normal left main, left anterior descending (LAD), and left circumflex (LCX) arteries.
CRIC2021-5598524.002.jpg
PMC8384542_01_CRIC2021-5598524.002.jpg
fig2
Troponin-I levels continued to rise sharply, peaking at 34.24 ng/ml, necessitating urgent coronary angiography via the right radial artery access, which revealed thrombosis in the pRCA, the rPL, and the distal PDA (Figure 2), at which point the patient underwent successful aspiration thrombectomy with the Pronto aspiration catheter system (Teleflex Medical OEM, Gurnee, IL, USA) without further evidence of underlying plaque or dissection. The distal PDA remained occluded in the aftermath of pRCA intervention, and attempts at aspiration thrombectomy were precluded by the small diameter of the vessel (<2 mm) (Figure 3).
Coronary angiography after intervention. pRCA and rPL s/p aspiration thrombectomy: coronary angiography (LAO view) showing complete resolution of thrombi in the pRCA and rPL branches after aspiration thrombectomy (white arrows). However, the PDA remained occluded with microthrombi as a consequence of intervention in the proximal RCA (white arrow).
CRIC2021-5598524.003.jpg
PMC8384542_01_CRIC2021-5598524.003.jpg
fig3
Troponin-I levels continued to rise sharply, peaking at 34.24 ng/ml, necessitating urgent coronary angiography via the right radial artery access, which revealed thrombosis in the pRCA, the rPL, and the distal PDA (Figure 2), at which point the patient underwent successful aspiration thrombectomy with the Pronto aspiration catheter system (Teleflex Medical OEM, Gurnee, IL, USA) without further evidence of underlying plaque or dissection. The distal PDA remained occluded in the aftermath of pRCA intervention, and attempts at aspiration thrombectomy were precluded by the small diameter of the vessel (<2 mm) (Figure 3).