Simultaneous total occlusion of multiple distal coronary arteries in acute myocardial infarction

Abstract

Simultaneous multiple coronary artery thrombosis is a rare finding in ST segment elevation myocardial infarction (STEMI). We report a case of myocardial infarction with multiple ST segment elevation on the electrocardiography and total occlusions of the distal left anterior descending artery (dLAD), as well as of the second and third obtuse marginal artery on emergency coronary angiography. Thrombus aspiration was performed at dLAD and systemic glycoprotein IIb/IIIa inhibitor was used successfully. In patients with STEMI, multiple coronary thromboses are unusual and associated with patient fatality. However, assertive thrombus aspiration and antiplatelet therapy could be effective in STEMI patients with multiple distal coronary artery occlusions.

Keywords: Coronary artery disease; Multiple; Myocardial infarction.

Fig. 1

The initial electrocardiogram on presentation.

Fig. 2

The initial and follow-up coronary angiography. The initial coronary angiography showed total occlusions of the distal left anterior descending artery (white arrow) and the second and third obtuse marginal branch (black arrow) of the left circumflex artery (A and B). Twenty-four hours later, the follow-up angiography showed normal blood flow in the previously occluded coronary arteries (C and D).