3rd International Conference on Cardiology (Hybrid Event)
November 30- December 01, 2023 | Dubai, UAE
Theme: Exploring New Research and Frontiers in Cardiology Care
Khurshid Ali
Lahore, Punjab Institute of Cardiology, PakistanTitle : CASE REPORT: A Rare Complication: Coronary Artery Spasm after Drug Eluting Stent Implantation During Percutaneous Intervention Leading to ST Elevation Myocardial Infarction
Abstract
Coronary artery spasm is
define as constriction of a coronary artery segment which may be focal or
diffuse, may b in single or more vessels
which is reversible and causes myocardial ischemia by restricting
coronary blood flow, leading to thrombus formation.
Coronary artery spasm is an
important cause of chest pain. Chest pain after successful PCI constitute a
considerable problem and some time fatal if caused by myocardial infarction.
Such pain constitute either residual coronary stenosis, acute occlusion, spasm
or myocardial infarction. The management of such kind complications involve
repeat coronary angiography and some additional interventions.
We present a case of coronary
artery spasm after drug eluting stent implantation during percutaneous intervention
(PCI) leading to ST Elevation Myocardial Infarction (STEMI), which is a rare
complication. A 65 year old female non diabetic, normotensive non smoker admitted with NSTEMI where she was given oral
and IV medication and then subjected to coronary angiogram in which showed
focal segment of severe disease in proximal RCA with normal other
coronaries. Her successful PCI to RCA
was carried-out, after two hours patient developed severe chest pain with
significant ST elevation in inferior leads. Patient was shifted to Cath Lab for
check injection which showed patent stent in RCA with severe diffuse spasm at
the stent outlet with intraluminal thrombus. Patient was put on IV
nitroglycerine and Tirofiban (Aggrastat) for next 24hrs. Patient became
asymptomatic after 3 hours. Recheck injection after three days showed patent
stent with mild mid disease (unchanged status as compared to the previous
angiogram) and TIMI III flow in distal vessel.
In conclusion, coronary
artery spasm along with intraluminal thrombus can be treated acutely with
intracoronary and intravenous nitroglycerine and Tirofiban (Aggrastat) while
long term management includes oral nitrates and calcium channel blocker along
with other routine medication.
Biography
Dr. Khurshid Ali completed
his MBBS from the Khyber Medical University, Pakistan following FCPS Cardiology
degree from the College of Physicians and Surgeons of Pakistan (CPSP) at the
age of 31 years. He completed his two years fellowship in Interventional
Cardiology at Punjab Institute of Cardiology, Lahore, Pakistan. He has published various original articles
and case reports in the distinguish journals. He is an active member of
Interventional Cardiology Team at Punjab Institute of Cardiology, Lahore.
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