Intracoronary artery retrograde thrombolysis for ST-segment elevation myocardial infarction with a tortuous coronary artery: A case report and review of the literature

Mingzhi Shen; Haihui Lu; Yichao Liao; Jian Wang; Yi Guo; Xinger Zhou; Yingqiao Nong; Zhenhong Fu; Jihang Wang; Yuting Guo; Shihao Zhao; Li Fan; Jinwen Tian

doi:10.3389/fcvm.2022.934489

Intracoronary artery retrograde thrombolysis for ST-segment elevation myocardial infarction with a tortuous coronary artery: A case report and review of the literature

Front Cardiovasc Med. 2022 Aug 4:9:934489. doi: 10.3389/fcvm.2022.934489. eCollection 2022.

Authors

Mingzhi Shen^{1

2}, Haihui Lu¹, Yichao Liao¹, Jian Wang¹, Yi Guo¹, Xinger Zhou^{1

2}, Yingqiao Nong^{1

2}, Zhenhong Fu³, Jihang Wang¹, Yuting Guo^{1

2}, Shihao Zhao¹, Li Fan⁴, Jinwen Tian^{1

2}

Affiliations

¹ Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China.
² The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
³ Department of Cardiology, Sixth Medical Center, PLA General Hospital, Beijing, China.
⁴ Department of Cardiology, Second Medical Center, PLA General Hospital, Beijing, China.

Abstract

Background: How to deal with large thrombus burdens of culprit's blood vessel remains a great challenge in the treatment of acute myocardial infarction.

Case presentation: A 32-year-old Chinese man was diagnosed with ST-segment elevation myocardial infarction (STEMI). Coronary angiography revealed that the distal end of a tortuous left circumflex was completely occluded by a large amount of thrombus. Cutted balloon-directed intracoronary artery retrograde thrombolysis (ICART) with urokinase led to the restoration of coronary blood flow. Because there was no obvious plaque rupture or artery stenosis in the coronary artery, it was only dilated, and no stent was implanted.

Conclusion: Cutted balloon-directed ICART can be performed effectively and safely in some STEMI patients with tortuous coronary vessels and large thrombus. (REST or named ICART ClinicalTrials.gov number, ChiCTR1900023849).

Keywords: intracoronary retrograde thrombolysis; myocardial infarction; reperfusion preconditioning; thrombosis; tortuous coronary artery.

Publication types

Case Reports