Successful Primary PCI in Stanford Type A Aortic Dissection Complicated by Inferior ST-Elevation Myocardial Infarction: A Case in a Facility with No Surgical Backup

2021 ◽  
Author(s):  
Suko Adiarto ◽  
Novi Kurnianingsih ◽  
Indra Prasetya ◽  
Faris W. Nugroho ◽  
Raman Uberoi
Keyword(s):  
Myocardial Infarction ◽  
Aortic Dissection ◽  
Elective Surgery ◽  
Aortic Surgery ◽  
Type A ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Corrective Surgery ◽  
Type A Aortic Dissection ◽  
St Elevation

AbstractMortality of type A aortic dissection (TAAD) complicated with coronary malperfusion syndrome is very high even when emergency surgery is performed. Several reports suggested that primary percutaneous coronary intervention (PPCI) followed by immediate corrective surgery may reduce mortality. In many countries, immediate transfer to an aortic surgery center may not be possible. We report a case of TAAD complicated by coronary malperfusion successfully treated with PPCI followed by elective corrective surgery. A 48-year-old man was referred to emergency department with acute inferior ST-elevation myocardial infarction (STEMI) and underwent PPCI. During the procedure, we realized that the cause of STEMI was TAAD. We decided to continue because the patient experienced seizures and bradycardia. Subsequently, echocardiography and computed tomography confirmed the dissection. The patient was discharged and referred to the National Cardiovascular Center where he underwent successful elective surgery. In this patient, immediate revascularization was lifesaving and served as a bridging procedure before surgical correction.

scholarly journals Primary Percutaneous Coronary Intervention in Chronic Type A Aortic Dissection

Aorta ◽  
2016 ◽  
Vol 04 (02) ◽  
pp. 68-71
Author(s):  
Ahmed Farag ◽  
Aneesha Chauhan ◽  
Sunita Avinash ◽  
Chee Liew ◽  
Jonas Eichhöfer ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Significant Risk ◽  
Type A ◽  
Coronary Intervention ◽  
Chronic Type ◽  
Type A Aortic Dissection ◽  
Percutaneous Coronary ◽  
Aortic Aneurysm And Dissection ◽  
St Elevation ◽  
Primary Percutaneous Intervention

AbstractThis case illustrates the complexities of performing a primary percutaneous intervention in a patient with chronic Type A aortic aneurysm and dissection with contraindications for surgical management. We also discuss the significant risk that the patient had to overcome to survive an undiagnosed aortic dissection and an acute ST elevation myocardial infarction.

False Lumen Catheterization in a Patient Who Has Type A Aortic Dissection That Mimics Acute Inferior Myocardial Infarction: A Case Report

2015 ◽  
Vol 18 (5) ◽  
pp. 208
Author(s):  
Erhan Kaya ◽  
Hakan Fotbolcu ◽  
Zeki Şimşek ◽  
Ömer Işık
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Aortic Dissection ◽  
Cardiac Catheterization ◽  
False Lumen ◽  
Type A ◽  
Inferior Myocardial Infarction ◽  
Type A Aortic Dissection ◽  
Acute Inferior Myocardial Infarction ◽  
Catheterization Procedure

We report a 61-year-old patient who suffered from a type A aortic dissection that mimicked an acute inferior myocardial infarction. During a routine cardiac catheterization procedure, diagnostic catheters can be inserted accidentally into the false lumen. Invasive cardiologists should keep this complication in mind.

Optimum Therapies for ST-Elevation Myocardial Infarction Managed with Primary Percutaneous Coronary Intervention

2012 ◽  
Vol 7 (2) ◽  
pp. 81
Author(s):  
Bruce R Brodie ◽  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Great Majority ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Stent Deployment ◽  
Aspiration Thrombectomy ◽  
Percutaneous Coronary ◽  
St Elevation

This article reviews optimum therapies for the management of ST-elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PCI). Optimum anti-thrombotic therapy includes aspirin, bivalirudin and the new anti-platelet agents prasugrel or ticagrelor. Stent thrombosis (ST) has been a major concern but can be reduced by achieving optimal stent deployment, use of prasugrel or ticagrelor, selective use of drug-eluting stents (DES) and use of new generation DES. Large thrombus burden is often associated poor outcomes. Patients with moderate to large thrombus should be managed with aspiration thrombectomy and patients with giant thrombus should be treated with glycoprotein IIb/IIIa inhibitors and may require rheolytic thrombectomy. The great majority of STEMI patients presenting at non-PCI hospitals can best be managed with transfer for primary PCI even with substantial delays. A small group of patients who present very early, who are at high clinical risk and have long delays to PCI, may best be treated with a pharmaco-invasive strategy.

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