[Intravascular ultrasound in recurrent myocardial ischemia and unremarkable coronary angiogram].
METHODS
3 months after sustaining an intramural anterior wall myocardial infarction (AWMI) a 57-year-old man was again admitted with the clinical and electrocardiographic (ECG) signs of an acute AWMI. As the activities of creatinine kinase (841 U/l) and of the myocardial isoenzyme (CKMB 143 U/l) were markedly elevated, thrombolysis with streptokinase was instituted. Subsequent left heart catheterization demonstrated discrete wall irregularity in the proximal branch of the anterior interventricular artery (PAIVA) and the right coronary artery, but no evidence of stenosing coronary heart disease.


METHODS
Because of the discrepancy in the findings, intravascular ultrasound imaging (IVUI) was performed. It revealed an eccentric unstable plaque in the PAIVA with a minimal cross-sectional stenosis of 3.3 mm2 (50% luminal narrowing). After stent implantation under IVUI a good primary result was achieved (stent cross-sectional area 6.2 mm2).


CONCLUSIONS
The usual cause of acute MI is rupture of an unstable, not flow-limiting and thus angiographically possibly "silent" plaque. IVUI can provide immediate assessment of atheromatous wall changes and can thus help to decide on further specific interventional measures.
Scheffold
N
N
Medizinische Klinik I, Städtisches Krankenhaus Heilbronn.
Schöngart
H
H
Kaag
N
N
Eisenlohr
E
E
Cyran
J
J
D006328:Cardiac Catheterization; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000601:surgery; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology; D003402:Creatine Kinase / Q000032:analysis; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000628:therapy; D012008:Recurrence; D015607:Stents; D013300:Streptokinase / Q000627:therapeutic use; D015912:Thrombolytic Therapy
D005343:Fibrinolytic Agents; D007527:Isoenzymes; D003402:Creatine Kinase; D013300:Streptokinase
Intravaskulärer Ultraschall bei rezidivierender Myokardischämie und unauffälligem Koronarangiogramm.