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  • Anterior STEMI complicating acute aortic syndrome: mechanistic insight and bridge to surgery with intravascular ultrasound-guided primary PCI

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Case Reports: Novel treatment (new drug/interventions; established drug/procedure in new situation)
Anterior STEMI complicating acute aortic syndrome: mechanistic insight and bridge to surgery with intravascular ultrasound-guided primary PCI
  1. Gautam Sen1,
  2. Alice Veitch2 and
  3. Sergio Nabais1
  1. 1 Department of Cardiology, Salisbury NHS Foundation Trust, Salisbury, Wiltshire, UK
  2. 2 Department of Radiology, Salisbury NHS Foundation Trust, Salisbury, Wiltshire, UK
  1. Correspondence to Dr Gautam Sen; gautamsen{at}nhs.net

Abstract

Stanford type A acute aortic syndromes (AAS) can be complicated with acute coronary closure and ST segment elevation myocardial infarction (STEMI) leading to significant additional morbidity and mortality. The recommended treatment for type A AAS is emergency cardiac surgery. We present the case of a patient with intramural haematoma involving the ascending and descending aorta complicated with anterior wall STEMI after CT imaging. Coronary angiography and intravascular ultrasonography (IVUS) revealed the dissection spiralling into the media of the left main stem (LMS) and left anterior descending (LAD) coronary artery. In the setting of acute vessel closure and ongoing myocardial ischaemia primary percutaneous coronary intervention (PCI) was performed to the LMS, LAD and second diagonal branch prior to successful emergency cardiac surgery with an aortic-arch interposition graft. Emergency IVUS-guided stenting to relieve acute coronary occlusion in the context of aortic dissection can be performed in selected cases to safely bridge the patient for cardiac surgery.

  • cardiovascular medicine
  • interventional cardiology
  • ischaemic heart disease
  • emergency medicine
  • cardiothoracic surgery

https://doi.org/10.1136/bcr-2021-248055

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    Footnotes

    • Contributors GS wrote the initial draft of the manuscript. AV and SN provided senior authorship. All of the authors have contributed to the development of this manuscript and generating the images and video files associated with the case.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.