PMC10118898_01
ECG shows ST elevation in inferior leads with first degree heart block.
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Health Stroke Scale score was calculated to be 12. Her baseline ECG in the emergency department depicted ST-segment elevation in the inferior leads and a first-degree heart block (Figure 1).
Cerebral CT angiography showing non-opacification of distal ICA and MCA (arrow).
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The cerebral CT angiography showed terminal internal carotid artery (ICA) occlusion on the right side (Figure 2).
CT cerebral angiogram shows (a) distal ICA occlusion with non-visualization of M1 MCA, (b) stentriever in situ with left ICA run showing a filling defect in distal ICA proximal M1 MCA (arrow), and (c) complete recanalization of ICA MCA.
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A right common carotid artery angiogram was taken, which confirmed the terminal right-sided ICA occlusion (Figures 3(a) and 3(b)). A total of two passes were taken and the final angiogram showed complete recanalization of the right ICA, MCA, and its branches [thrombolysis in cerebral infarction (TICI) 3 recanalization; Figure 3(c)].
CAG showing (a) diffusely diseased RCA with maximum stenosis of 80-90% at the mid part with 100% occlusion of AM, (b) CTO of LAD from the mid part and small caliber Left circumflex artery, and (c) TIMI 3 flow after RCA revascularization.
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It was also noted that she had two large acute marginal (AM) branches:the first had 90-95% focal stenosis, and the second was 100% occluded (Figures 4(a) and 4(b)). A final angiogram confirmed thrombolysis in myocardial infarction (TIMI) flow of 3 in both arteries (Figure 4(c)). Any additional IV UFH was not given during the coronary angioplasty because the activated clotting time was adequate from the previously infused UFH during the mechanical thrombectomy.