Primary stenting in acute myocardial infarction secondary to right coronary artery dissection following blunt chest trauma. Usefulness of intracoronary ultrasound

Moreno, Raúl; Todo, Jesús Pérez del; Nieto, M.; Alba, Francisco; Alfonso, Fernándo; Garcia-Rubira, Juan Carlos; Fernández‐Ortíz, Antonio; Hernández, Rosana; Macaya, Carlos

doi:10.1016/j.ijcard.2004.06.021

Cited by 20 publications

(9 citation statements)

References 11 publications

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“…Coronary artery stenting is the advised treatment modality most often reported in previous data. [1] Although it requires aggressive anti-platelet treatment, it is still an important procedure in the setting of acute trauma and is minimally invasive. On the other hand, the use of adjunctive anti-platelet drugs must be individualized depending on the risk of stent thrombosis versus the bleeding threat from associated injuries.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Management of Acute Myocardial Infarction after a Blunt Chest Trauma

Özdoğan¹,

Karaçelik²,

Ekmekçi³

et al. 2013

Ulus Travma Acil Cerrahi Derg

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Coronary artery dissection is a rare complication after blunt chest trauma. Patients usually present with sudden death and the diagnosis is frequently missed. In this report, we present a case of a 46-year-old with a hyperacute anterior wall myocardial infarction after blunt chest trauma. Diagnostic coronary angiography showed total occlusion of the left anterior descending coronary artery (LAD) starting at the takeoff of the vessel from the left main coronary artery (LMCA). A bare-metal stent was immediately deployed at the proximal LAD and TIMI 3 flow was achieved; however post-procedural images revealed no satisfactory results. A proximal dissection and intraluminal thrombus extending to the LMCA was observed. Because of the proximity of the lesion to the LMCA, re-intervention was considered to be risky and urgent coronary artery bypass grafting (CABG) was planned. Coronary artery stenting is the advised treatment modality for coronary occlusion after blunt chest trauma. However, post-traumatic percutaneous coronary intervention was sometimes considered to be risky because of the anatomic features of the lesion. Timing is cardinal in achieving early reperfusion in the course of myocardial infarction after blunt chest trauma and CABG should be the preferred procedure for initial reperfusion treatment especially in proximal LAD dissections with subsequent thrombus formation leading to total occlusion of the artery.Key Words: Chest trauma; coronary artery dissection; percutaneous coronary intervention.Künt göğüs travması sonrası koroner arter diseksiyonu nadir bir komplikasyondur. Hastalar genellikle ani ölüm ile gelirler ve tanı çoğu zaman atlanmaktadır. Bu yazıda künt göğüs travması sonrası hiperakut önyüz miyokart enfarktüsü gelişen 46 yaşında bir olgu sunuldu. Tanısal koroner anjiyografi sol ana koroner arter çıkışından başlayan sol ön inen arterin (LAD) total oklüzyonunu göstermekteydi. Koroner anjiyografi sonrası hızlıca proksimal LAD'ye çıplak stent yerleştirildi ve TIMI 3 akım elde edildi; fakat işlem sonrası görüntüler tatminkâr sonuçlar göstermedi. Proksimal bir diseksiyon ve sol ana koronere yayılan intraluminal trombüs gözlendi. Lezyonun sol ana koroner artere yakınlığından dolayı tekrar girişim riskli bulundu ve acil koroner arter baypas greftleme (CABG) planlandı. Koroner arter stentleme, künt göğüs travması sonrası gelişen koroner tıkanıklıkta tavsiye edilen tedavi yöntemidir. Fakat lezyonun anatomik özelliklerine bağlı olarak perkütan koroner girişim bazen riskli olarak kabul edilmektedir. Künt göğüs travması sonrası miyokart enfarktüsü durumunda erken reperfüzyonun sağlanmasında zamanlama önemlidir ve CABG özellikle damarın total oklüzyonuna yol açan trombüs oluşumu ile birlikte olan proksimal LAD diseksiyonlarında başlangıç reperfüzyon tedavisi için tercih edilen yöntem olmalıdır.Anahtar Sözcükler: Göğüs travması; koroner arter diseksiyonu; perkutan koroner girişim.

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Section: Discussionmentioning

confidence: 99%

“…Coronary artery dissection is a rare complication after blunt chest trauma. [1,2] The diagnosis is frequently missed or delayed and since many of the patients present with sudden death, it is an unusual consequence of blunt chest trauma.…”

mentioning

confidence: 99%

Management of Acute Myocardial Infarction after a Blunt Chest Trauma

Özdoğan¹,

Karaçelik²,

Ekmekçi³

et al. 2013

Ulus Travma Acil Cerrahi Derg

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“…The mechanism was expected as subintimal hemorrhage or intimal tear. Moreno et al (17) reported that they treated an occluded RCA after blunt chest trauma with percutaneous coronary intervention, and they found intimal dissection and subintimal hematoma in the intravascular ultrasound image. We chose an urgent coronary artery bypass graft in this case for the acute phase.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Resolution of an Accidental Total Coronary Occlusion

et al. 2010

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In December 2007, a woman was involved in a traffic accident. At first, her vital signs were normal, but electrocardiogram showed ST-segment elevation in the inferior leads. She was diagnosed as a blunt chest trauma-induced myocardial infarction. Her right coronary angiography showed total occlusion. She underwent an emergency coronary artery bypass surgery; 64-multi-detector-row computed tomography (64-MDCT) demonstrated an intravascular protruding lesion, which suggested subintimal hematoma. One month later, repeat coronary angiogram showed spontaneous recanalization, and 64-MDCT showed no discontinuous vessel wall. Coronary artery occlusion secondary to blunt chest trauma is rare, and it's even rarer to have spontaneous recanalization.

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“…Coronary artery dissection is a rare condition which accounts for 15.8% of myocardial infarction due to blunt chest trauma [2]. Dissection most often occurs in the left anterior descending artery [3], but it also occurs in the right coronary artery [4]. Although rare, left main coronary artery involvement has also been reported [5].…”

Section: Discussionmentioning

confidence: 99%