Simultaneous Total Occlusion of Multiple Distal Coronary Arteries in Acute Myocardial Infarction

Abstract

Simultaneous multiple coronary artery thrombosis is a rare finding in ST segment elevation myocardial infarction (STEMI). We report a case of myocardial infarction with multiple ST segment elevation on the electrocardiography and total occlusions of the distal left anterior descending artery (dLAD), as well as of the second and third obtuse marginal artery on emergency coronary angiography. Thrombus aspiration was performed at dLAD and systemic glycoprotein IIb/IIIa inhibitor was used successfully. In patients with STEMI, multiple coronary thromboses are unusual and associated with patient fatality. However, assertive thrombus aspiration and antiplatelet therapy could be effective in STEMI patients with multiple distal coronary artery occlusions.

Angiographic and clinical characteristics of type 1 versus type 2 perioperative myocardial infarction

“…Interestingly, type 1 patients had a significantly greater number of complex lesions. These findings are consistent with prior observations that in many patients with acute coronary syndromes, plaque instability is a multifocal process .…”

Simultaneous double coronary thrombosis in a 47-year-old male patient with acute myocardial infarction

“…Other cases were reported following cocaine abuse [16] and during puerperium [17]. In a few other cases, the cause was unclear [18,19]. We believe that the pathogenesis of multiple coronary occlusive lesions may be explained by the simultaneous rupture of multiple plaques during the progression of myocardial infarction.…”

Multiple distal coronary artery thrombosis in acute myocardial infarction: a rare presentation

“…A possible pathogenic mechanism is multiple plaque ruptures as a result of diffuse inflammatory process ‘pan-arteritis’ involving multiple coronary arteries 2. Another hypothesis states that ischaemic event in one coronary artery might lead to impairment of blood flow in the other vessels (secondary to transient ventricular dysfunction or arrhythmias), resulting in thrombus formation.…”