title: Contrast media injection into right coronary artery caused thrombus extraction to aorta that may have resulted in left main trunk thrombosis.
abstract: A 59-year-old man with inferior acute myocardial infarction underwent an urgent coronary angiography and as a result a total occlusion of the ostial right coronary artery (RCA) was observed. Interestingly, the thrombus in the RCA clearly shortened within 2.3 s during the contrast media injection. While we prepared for percutaneous coronary intervention (PCI) of the RCA, ventricular fibrillation occurred and pulseless electrical activity continued in spite of repeated cardioversion. Despite no stenosis in the left main trunk (LMT) in the initial coronary angiography, the LMT was totally occluded. Following aspiration therapy on the LMT with percutaneous cardiopulmonary support, PCI of the RCA was performed. A coronary angiography should be carefully performed if a lot of thrombi exist in the coronary ostium because LMT embolism may have been caused by thrombus extraction from the RCA by contrast media injection.
authors.affiliation: Division of Cardiology, Heart and Vascular Institute, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, 273-8588, Chiba, Japan, atsuzou@d2.dion.ne.jp.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ikeda
authors.forename: Masayuki
authors.initials: M
authors.lastname: Inagaki
authors.forename: Shigeru
authors.initials: S
authors.lastname: Fukuzawa
authors.forename: Juji
authors.initials: J
authors.lastname: Sugioka
authors.forename: Shinichi
authors.initials: S
authors.lastname: Okino
authors.forename: Junpei
authors.initials: J
authors.lastname: Maekawa
authors.forename: Sachiko
authors.initials: S
authors.lastname: Maekawa
authors.forename: Soichiro
authors.initials: S
authors.lastname: Ichikawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Uchiyama
authors.forename: Norihiko
authors.initials: N
authors.lastname: Kamioka
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Kuroiwa
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology; D003287:Contrast Media / Q000009:adverse effects; D017023:Coronary Angiography / Q000009:adverse effects* / Q000379:methods; D003328:Coronary Thrombosis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000601:surgery; D018450:Disease Progression; D004554:Electric Countershock / Q000379:methods; D004638:Emergency Treatment; D005500:Follow-Up Studies; D006801:Humans; D056989:Inferior Wall Myocardial Infarction / Q000000981:diagnostic imaging* / Q000628:therapy*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic / Q000379:methods; D018570:Risk Assessment; D017131:Thrombectomy / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy
chemical_list: D003287:Contrast Media