PMC6362489_01
PMC6362489_02
Presenting ECG at our institution: significant anterior and lateral ST elevations along with anterior and lateral Q waves. Based on this ECG as well as his extremis presentation, he was brought emergently to the cardiac catheterization lab.
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fig1
ECG showed an anterolateral STEMI (Figure 1). ECASA 160 mg and ticagrelor 180 mg were given to the patient via the NG tube, and 4000 units of IV heparin was administered.
(a). RAO projection demonstrating a normal and patent RCA and left-sided collaterals (white arrows). See Supplementary Video 1 for CINE. (b). RAO caudal projection of LCA. The LAD is occluded (*), and proximal LCX has a long 90% proximal stenosis (white arrows) and fills poorly after a large first obtuse marginal branch. See Supplementary Video 2 for CINE.
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Selective coronary angiography demonstrated a normal right coronary artery with collaterals to the left circumflex artery (LCX), complete occlusion of his left anterior descending artery (LAD), and a long 90% lesion of the proximal LCX (Figures 2(a) and 2(b), Supplementary Videos 1 and 2).
RAO caudal projection after initial ballooning of the LAD and LCX: extensive thrombus burden is noted in the LAD (*) and a 90% proximal LCX lesion (white arrows). See Supplementary Video 3 for CINE.
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fig3
PMC6362489_03
(a). RAO caudal projection. After PCI, the left main artery, LAD, and LCX are patent. See Supplementary Video 4 for CINE. (b). Diffuse distant vasoconstriction of the coronary arteries (white arrows) following PCI due to high doses of IV norepinephrine, epinephrine, and vasopressin. See Supplementary Video 5 for CINE.
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fig4
Eventually, the de novo coronary thrombosis stopped, and complex bifurcation stenting of the LAD, left main artery, and LCX could be performed using 2 drug-eluting stents and a bifurcation minicrush technique (Figure 4, Supplementary Videos 4 and 5).
PMC6362489_04
PMC6362489_05