Image in Cardiology
Simultaneous acute closure of the right coronary artery and left anterior descending artery in a young male
Encerramanto agudo simultâneo da artéria coronária direita e da artéria descendente anterior esquerda num homem jovem
Ewa Szczerba, Karol Zbroński
, Zenon Huczek, Robert Kowalik, Grzegorz Opolski
Corresponding author
First Department of Cardiology, Medical University of Warsaw, Warsaw, Mazovia, Poland
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"identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "Zenon" "apellidos" => "Huczek" ] 3 => array:2 [ "nombre" => "Robert" "apellidos" => "Kowalik" ] 4 => array:2 [ "nombre" => "Grzegorz" "apellidos" => "Opolski" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "First Department of Cardiology, Medical University of Warsaw, Warsaw, Mazovia, Poland" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Encerramanto agudo simultâneo da artéria coronária direita e da artéria descendente anterior esquerda num homem jovem" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 392 "Ancho" => 996 "Tamanyo" => 92693 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Acute thrombosis of the left anterior descending artery, TIMI flow 0 (a); spontaneous reperfusion revealing a massive thrombus in segment 7 (b); status following stent implantation, TIMI flow 3 (c).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 28-year-old man with no cardiovascular history or cardiovascular risk factors, who denied cigarette smoking or taking any medications, drugs, supplements or steroids, was referred to the cardiology department after an out-of-hospital cardiac arrest preceded by a four-hour angina episode. The initial rhythm (ventricular fibrillation) was successfully defibrillated. Subsequently, the electrocardiogram suggested inferior and inferobasal ST-elevation myocardial infarction (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The coronary angiogram showed simultaneous acute thrombosis of the right coronary artery (RCA) (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>a) and of the left anterior descending (LAD) artery (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>a). Initially, to visualize suspected plaque rupture and to aid the decision whether to implant stents, multiple aspiration thrombectomies were performed, resulting in removal of substantial amounts of thrombotic material (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>). After intravenous and intracoronary administration of abciximab, an everolimus-eluting stent was implanted into the RCA, restoring good epicardial coronary flow (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>b). In the LAD spontaneous reperfusion occurred, revealing a massive thrombus (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>b). After aspiration thrombectomy, a stent was implanted (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>c). Echocardiographic examination revealed inferior wall and basal septal akinesis with ejection fraction of 35%. Right ventricular enlargement (5.4 cm in apical 4-chamber view) and hypokinesis (tricuspid annular plane systolic excursion [TAPSE] 14 mm) were present. Right ventricular function was improved on control echocardiography (TAPSE 27 mm).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Additional diagnostics available in our center failed to identify the cause of massive thrombus formation in both coronary arteries. An inflammatory etiology causing massive atherosclerotic plaque destabilization seemed unlikely, as C-reactive protein levels were normal on admission (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The patient was referred to the hematological department due to suspicion of thrombophilia.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosure</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical disclosure" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-01-15" "fechaAceptado" => "2016-06-20" "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 379 "Ancho" => 1384 "Tamanyo" => 188177 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Teletransmitted electrocardiogram demonstrating inferior and inferobasal ST-elevation myocardial infarction and suggesting closure of the right coronary artery.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 384 "Ancho" => 651 "Tamanyo" => 65016 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Acute thrombosis of the right coronary artery, TIMI flow 0 (a); status following stent implantation, TIMI flow 3 (b).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 392 "Ancho" => 996 "Tamanyo" => 92693 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Acute thrombosis of the left anterior descending artery, TIMI flow 0 (a); spontaneous reperfusion revealing a massive thrombus in segment 7 (b); status following stent implantation, TIMI flow 3 (c).</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 801 "Ancho" => 601 "Tamanyo" => 121771 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Thrombotic material retrieved via aspiration thrombectomies.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">HDL: high-density lipoprotein; LDL: low-density lipoprotein; TSH: thyroid-stimulating hormone.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total cholesterol (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">144 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LDL cholesterol (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HDL cholesterol (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Triglycerides (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">C-reactive protein (mg/l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fibrinogen (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">200 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Glucose (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TSH (μIU/ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.93 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Creatinine (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1324002.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Selected baseline laboratory results.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003600000001/v1_201701200114/S2174204916302781/v1_201701200114/en/main.assets" "Apartado" => array:4 [ "identificador" => "9915" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in cardiology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003600000001/v1_201701200114/S2174204916302781/v1_201701200114/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916302781?idApp=UINPBA00004E" ]
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| 2024 September | 32 | 22 | 54 |
| 2024 August | 34 | 23 | 57 |
| 2024 July | 40 | 37 | 77 |
| 2024 June | 38 | 22 | 60 |
| 2024 May | 36 | 16 | 52 |
| 2024 April | 31 | 24 | 55 |
| 2024 March | 29 | 21 | 50 |
| 2024 February | 22 | 23 | 45 |
| 2024 January | 27 | 28 | 55 |
| 2023 December | 28 | 27 | 55 |
| 2023 November | 22 | 28 | 50 |
| 2023 October | 21 | 20 | 41 |
| 2023 September | 16 | 20 | 36 |
| 2023 August | 24 | 21 | 45 |
| 2023 July | 30 | 12 | 42 |
| 2023 June | 22 | 14 | 36 |
| 2023 May | 36 | 24 | 60 |
| 2023 April | 16 | 7 | 23 |
| 2023 March | 29 | 29 | 58 |
| 2023 February | 39 | 23 | 62 |
| 2023 January | 20 | 10 | 30 |
| 2022 December | 27 | 23 | 50 |
| 2022 November | 44 | 22 | 66 |
| 2022 October | 28 | 19 | 47 |
| 2022 September | 43 | 27 | 70 |
| 2022 August | 39 | 32 | 71 |
| 2022 July | 28 | 27 | 55 |
| 2022 June | 30 | 20 | 50 |
| 2022 May | 23 | 26 | 49 |
| 2022 April | 29 | 32 | 61 |
| 2022 March | 39 | 30 | 69 |
| 2022 February | 35 | 27 | 62 |
| 2022 January | 25 | 22 | 47 |
| 2021 December | 29 | 24 | 53 |
| 2021 November | 43 | 32 | 75 |
| 2021 October | 51 | 46 | 97 |
| 2021 September | 37 | 27 | 64 |
| 2021 August | 41 | 25 | 66 |
| 2021 July | 33 | 27 | 60 |
| 2021 June | 32 | 26 | 58 |
| 2021 May | 33 | 48 | 81 |
| 2021 April | 37 | 32 | 69 |
| 2021 March | 56 | 23 | 79 |
| 2021 February | 41 | 15 | 56 |
| 2021 January | 31 | 9 | 40 |
| 2020 December | 27 | 6 | 33 |
| 2020 November | 33 | 14 | 47 |
| 2020 October | 17 | 11 | 28 |
| 2020 September | 68 | 13 | 81 |
| 2020 August | 32 | 8 | 40 |
| 2020 July | 47 | 5 | 52 |
| 2020 June | 30 | 10 | 40 |
| 2020 May | 41 | 2 | 43 |
| 2020 April | 43 | 14 | 57 |
| 2020 March | 44 | 4 | 48 |
| 2020 February | 98 | 37 | 135 |
| 2020 January | 36 | 6 | 42 |
| 2019 December | 37 | 4 | 41 |
| 2019 November | 20 | 6 | 26 |
| 2019 October | 28 | 4 | 32 |
| 2019 September | 49 | 9 | 58 |
| 2019 August | 35 | 5 | 40 |
| 2019 July | 31 | 14 | 45 |
| 2019 June | 35 | 8 | 43 |
| 2019 May | 30 | 16 | 46 |
| 2019 April | 24 | 14 | 38 |
| 2019 March | 29 | 6 | 35 |
| 2019 February | 35 | 10 | 45 |
| 2019 January | 41 | 5 | 46 |
| 2018 December | 32 | 13 | 45 |
| 2018 November | 44 | 10 | 54 |
| 2018 October | 77 | 9 | 86 |
| 2018 September | 37 | 9 | 46 |
| 2018 August | 24 | 5 | 29 |
| 2018 July | 17 | 2 | 19 |
| 2018 June | 36 | 10 | 46 |
| 2018 May | 22 | 5 | 27 |
| 2018 April | 36 | 13 | 49 |
| 2018 March | 36 | 2 | 38 |
| 2018 February | 20 | 3 | 23 |
| 2018 January | 31 | 6 | 37 |
| 2017 December | 27 | 4 | 31 |
| 2017 November | 15 | 11 | 26 |
| 2017 October | 13 | 7 | 20 |
| 2017 September | 12 | 5 | 17 |
| 2017 August | 13 | 7 | 20 |
| 2017 July | 10 | 3 | 13 |
| 2017 June | 26 | 13 | 39 |
| 2017 May | 20 | 8 | 28 |
| 2017 April | 11 | 3 | 14 |
| 2017 March | 35 | 31 | 66 |
| 2017 February | 49 | 15 | 64 |
| 2017 January | 23 | 8 | 31 |
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