Rescue percutaneous coronary intervention for failed thrombolysis in a patient with anomalous coronary arteries.
Coronary artery anomalies (CAA) often render technically difficult the completion of coronary angiography and intervention. Their presence in patients undergoing emergency angiography for acute myocardial infarction (AMI) is particularly challenging for interventional cardiologists. In this article, we report, for the first time in the literature, a case of rescue percutaneous coronary intervention for failed thrombolysis in a patient with AMI due to occlusion of a left circumflex coronary artery with anomalous origin from right sinus of Valsalva (in an anomalous left coronary system also including an anomalous origin of the left anterior descending artery from the right sinus). In particular, the present clinical vignette emphasizes the importance of a thorough search for the culprit vessel during cardiac catheterization. Especially in the emergency setting, non-invasive methods of ischemia localization, such as ST-segment elevation at the ECG and wall motion abnormalities at echocardiography, are of pivotal usefulness to guide the interventional cardiologist in identifying and treating the diseased coronary vessel in a timely and effective fashion.
Mazzari
Mario
M
Biondi-Zoccai
Giuseppe G L
GG
Burzotta
Francesco
F
Trani
Carlo
C
Ramazzotti
Vito
V
Romagnoli
Enrico
E
Savino
Marinica
M
Abbate
Antonio
A
Parisi
Quintino
Q
Rebuzzi
Antonio G
AG
Mongiardo
Rocco
R
Crea
Filippo
F
D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D017023:Coronary Angiography; D003330:Coronary Vessel Anomalies / Q000150:complications* / Q000000981:diagnostic imaging; D004638:Emergency Treatment / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D015912:Thrombolytic Therapy; D017211:Treatment Failure