Document Detail


Recurrent myocardial ischemia due to riding left main coronary artery bifurcation thrombus--noninterventional therapy with glycoprotein blocker and thrombolysis.
MedLine Citation:
PMID:  16757405     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Acute coronary syndrome (ACS) comprises different manifestations of coronary artery disease. Angiograms performed at the time of an ACS may present different coronary morphologies; mostly there are acute vessel occlusions, ruptured atherosclerotic plaques, or thrombotic lesions that require reperfusion therapy. In the presence of intracoronary thrombi localized in the left main coronary artery, the clinical situation is challenging. Hemodynamic situation, symptoms, and rhythm status may change immediately and entail high mortality. Catheter-based therapy and surgical revascularization are associated with a high mortality rate. A noninterventional approach may be chosen in patients with stable hemodynamics and reestablished perfusion.
METHODS AND PATIENT: We describe a patient with acute ST-elevation myocardial infarction with chest pain and stable hemodynamics. Angiography revealed a large thrombus in the left main coronary artery bifurcation with ostial subtotal narrowing of the circumflex and left anterior descending artery. However, coronary perfusion was maintained. Immediate treatment with the glycoprotein IIb/IIIa inhibitor abciximab was performed. The patient became asymptomatic. Angiography the next day showed no change in thrombus formation, so abciximab infusion was prolonged. Initial elevated enzymes decreased to normal values. Three days later the patient developed a new unstable angina with newly elevated cardiac enzymes. At this time, a thrombolytic agent was administered. Angiography 2 days later demonstrated normal coronaries.
CONCLUSION: This case demonstrates the impact of intracoronary thrombi on repetitive myocardial ischemia and the effectiveness of a noninterventional pharmacological approach for the treatment of acute myocardial infarction due to intracoronary thrombus even in the left main coronary bifurcation.
Authors:
Alfried Germing; Andreas Mügge; Michael Lindstaedt
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Cardiovascular revascularization medicine : including molecular interventions     Volume:  7     ISSN:  1553-8389     ISO Abbreviation:  Cardiovasc Revasc Med     Publication Date:    2006 Apr-Jun
Date Detail:
Created Date:  2006-06-07     Completed Date:  2006-10-31     Revised Date:  2013-07-15    
Medline Journal Info:
Nlm Unique ID:  101238551     Medline TA:  Cardiovasc Revasc Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  76-80     Citation Subset:  IM    
Affiliation:
Medical Clinic II, Cardiology and Angiology, BG-Kliniken Bergmannsheil, University of Bochum, 44789 Bochum, Germany. alfried.germing@rub.de
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MeSH Terms
Descriptor/Qualifier:
Adult
Antibodies, Monoclonal / therapeutic use*
Anticoagulants / therapeutic use*
Coronary Vessels / physiopathology*
Female
Follow-Up Studies
Humans
Immunoglobulin Fab Fragments / therapeutic use*
Myocardial Ischemia / drug therapy*,  physiopathology*
Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors
Recurrence
Thrombolytic Therapy*
Thrombosis / drug therapy*
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Anticoagulants; 0/Immunoglobulin Fab Fragments; 0/Platelet Glycoprotein GPIIb-IIIa Complex; X85G7936GV/abciximab

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