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Case Reports
. 2011 Jun 15;4(1):e1-e4.
doi: 10.1016/j.jccase.2011.05.002. eCollection 2011 Aug.

Acute myocardial infarction involving double vessel total occlusion of the left anterior descending and left circumflex arteries: A case report

Hidehira Fukaya  1   2 , Jun Oikawa  1   2 , Shoji Hirasawa  1   2 , Takao Shimohama  2 , Taiki Tojo  2 , Shinichi Niwano  2 , Tohru Izumi  2
Affiliations
Case Reports

Acute myocardial infarction involving double vessel total occlusion of the left anterior descending and left circumflex arteries: A case report

Hidehira Fukaya et al. J Cardiol Cases. .

Abstract

A 66-year-old Japanese man complained of chest pain consistent with acute myocardial infarction (AMI). His electrocardiogram showed ST segment elevation in the anterior and inferior leads. Emergency coronary angiography revealed occlusion of the proximal left anterior descending artery (LAD) and middle left circumflex artery (LCx). An intra-aortic balloon pump (IABP) was inserted to restore antegrade coronary flow in these vessels. Coronary stents were subsequently implanted at the culprit lesions. Although previous reports of multivessel coinstantaneous AMI are rare and indicate a poor prognosis, he had a relatively benign course and was discharged with New York Heart Association functional class I without post-operational complications.

Keywords: Acute myocardial infarction; Double vessel occlusion; Intra-aortic balloon pump.

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Figures

Figure 1
Figure 1
Changes in ECG over time. ECGs were obtained at the patient's local clinic (A), our ED (B), our ED just before CAG (C), and after 4 months (D). (A) Tall T wave in anterior lead. (B) ST segment elevation in anterior lead. (C) Intraventricular conduction delay and additional ST segment elevation in inferior lead. (D) Poor R progression and left axis deviation. ECG, electrocardiogram; ED, emergency department; CAG, coronary angiography.
Figure 2
Figure 2
CAG results. CAG results in RAO-caudal view (A) and LAO-cranial view (B). Total occlusion of the proximal LAD (black arrow) and middle LCx (white arrow) are visible. The final CAG after PCI is also shown in same direction (C) RAO-caudal and (D) LAD-cranial. TIMI grade III flow was observed in both the LAD and the LCx. CAG, coronary angiography; LCx, left circumflex artery; LAD, left anterior descending artery; RAO, right anterior oblique; LAO, left anterior oblique; PCI, percutaneous coronary intervention; TIMI, Thrombolysis In Myocardial Infarction.
Figure 3
Figure 3
IVUS results. Left and right panels show IVUS results for the LCx and LAD, respectively. (A, B, and C) Show the area proximal to the culprit, the culprit, and distal to it in the LCx, respectively. (D), (E), and (F) Show the same respective areas in the LAD. Both coronary artery lesions contained lipid-rich plaque. In particular, (E) shows findings of attenuation, indicating lipid-rich, vulnerable plaque. IVUS, intravascular ultrasound; LAD, left anterior descending artery; LCx, left circumflex artery.
See this image and copyright information in PMC

References

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