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30 December 2016 : Case report  USA

Complete Revascularization of Simultaneous Multiple Culprit Lesions in a Septuagenarian with ST-Elevation Myocardial Infarction

Unusual clinical course, Management of emergency care, Educational Purpose (only if useful for a systematic review or synthesis)

Ikechukwu A. Ifedili1ABCDEF, Tamunoinemi Bob-Manuel2ABCDEFG, Oluwaseyi Bolorunduro1ABCDEF, Raza Askari1ABCDEF, Uzoma N. Ibebuogu1ABCDEF*

DOI: 10.12659/AJCR.900849

Am J Case Rep 2016; 17:997-1001

Abstract

BACKGROUND: ST-elevation myocardial infarction (STEMI) is usually caused by rupture of unstable plaque with thrombus formation and abrupt cessation of blood flow through a single coronary artery that is deemed the culprit. The simultaneous thrombotic occlusions of multiple coronary arteries in the setting of STEMI is a rare occurrence with implications for patient management and outcome not fully addressed in the current STEMI guidelines, although more recent studies suggest a benefit of complete revascularization compared to culprit vessel-only treatment in the setting of STEMI.

CASE REPORT: A 74-year-old female presented with STEMI. Coronary angiography revealed simultaneous multiple coronary thrombotic occlusions involving the right coronary, left circumflex, and ramus intermedius arteries successfully treated with primary percutaneous revascularization at the same setting with good outcome and short hospital length of stay.

CONCLUSIONS: Although the most appropriate timing to treat simultaneous multiple culprit lesions has yet to be definitively defined, multi-vessel percutaneous coronary intervention in the setting of a STEMI with multiple culprit lesions is feasible with good outcome as shown by our index case. 

Keywords: acute coronary syndrome, Angioplasty, Balloon, Coronary, Anterior Wall Myocardial Infarction

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923