Yıl: 2020 Cilt: 48 Sayı: 3 Sayfa Aralığı: 304 - 308 Metin Dili: İngilizce DOI: doi: 10.5543/tkda.2019.57070 İndeks Tarihi: 15-11-2020

Coronary stent embolism to the right posterior cerebral artery

Öz:
A 57-year-old male was admitted to the emergency room with chest pain that has been present for 3 hours. His blood pressure was 70/50 mmHg and heart rate was 48 bpm. 12-lead surface electrocardiography revealed inferior myocardial infarction and third-degree atrioventricular (AV) block. An emergency coronary angiography showed a 50% stenosis in the middle segment of the left anterior descending artery and 90% in the proximal circumflex (Cx) artery. The right coronary artery was totally occluded. After the predilatation with a 2.0x15 mm compliant balloon at 10 atm, a 3.5x24 mm bare metal stent was implanted. The thirddegree AV block improved and a sinus rhythm of 124 bpm was achieved, but hemodynamic stability was not attained. Percutaneous coronary intervention for the Cx artery was performed. Without predilatation, a 3.5x12 mm low profile BMS was easily advanced over the lesion. Just before the stent implantation, asystole developed, followed by convulsions. Blood pressure and heart rate recovered after the administration of 1 mg of atropine. However, during the seizure, the guidewire and coronary stent device fell to the aortic root. Stent struts were not seen on the balloon catheter in a fluoroscopic examination. Fluoroscopic scanning of the vascular system showed that the coronary stent was in the right posterior cerebral artery. There were no symptoms or signs of neurological disorder. Consultant invasive neuroradiologist recommended medical follow-up. Clopidogrel and acetylsalicylic acid were prescribed indefinitely. Two months after the primary PCI, a successful coronary artery bypass graft operation was performed. After 4 years, the patient remained without any symptoms of neurological problems.
Anahtar Kelime:

Sağ posteriyor serebral artere embolize olan koroner stent olgusu

Öz:
Elli yedi yaşında erkek hasta acile üç saatlik göğüs ağrısı ile başvurdu. Kan basıncı 70/50 mmHg ve kalp hızı 48/dk idi. 12 derivasyonlu elektrokardiyografide inferiyor miyokart infarktüsü ile birlikte üçüncü derece atriyoventriküler (AV) blok gözlendi. Acil yapılan koroner anjiyografi, sol ön inen arterin orta segmentinde %50, proksimal sirkumfleks (Cx) arterde %90 darlık olduğunu gösterdi. Sağ koroner arterde tam tıkanıklık saptandı. 2.0x15 mm komplian balon ile 10 atm’de predilatasyon sonrası 3.5x24 mm çıplak metal stent takıldı. Üçüncü derece AV blok düzeldi ve 124/dk hızında sinüs ritmi sağlandı, fakat hastanın hemodinamisinin düzelmemesi üzerine Cx lezyonuna girişim planlandı. Predilatasyon olmadan 3.5x12 mm düşük profilli çıplak metal stent kolayca lezyonu geçti. İmplantasyondan hemen önce asistoli ve konvülziyon gelişti. 1 mg atropin uygulandıktan sonra kalp hızı ve kan basıncı değerleri toparlandı. Kılavuz tel ve stentin koroner arterden çıkarak aortaya düştüğü gözlendi. Sonrasında f loroskopide, balon kateter üzerinde stent gözlenemedi. Vasküler sistemin floroskopik taramasında stentin sağ posteriyor serebral arterde olduğu saptandı. Hastada nörolojik bozukluk belirtisi veya bulgusu yoktu. İnvazif nöroradyoloji konsültasyonu medikal takip önerdi. Klopidogrel ve aspirinden oluşan ikili antiagregan tedavi ömür boyu olmak üzere verildi. Primer perkütan koroner girişimden 2 ay sonra hastaya başarılı koroner baypas cerrahisi yapıldı. Dördüncü yıl takibinde hastanın nörolojik bulgusu yoktu.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Olgu Sunumu Erişim Türü: Erişime Açık
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APA varol s, sahin i, KUM G, katkat f, OKUYAN E (2020). Coronary stent embolism to the right posterior cerebral artery. , 304 - 308. doi: 10.5543/tkda.2019.57070
Chicago varol sinan,sahin irfan,KUM Gökmen,katkat fahrettin,OKUYAN ERTUGRUL Coronary stent embolism to the right posterior cerebral artery. (2020): 304 - 308. doi: 10.5543/tkda.2019.57070
MLA varol sinan,sahin irfan,KUM Gökmen,katkat fahrettin,OKUYAN ERTUGRUL Coronary stent embolism to the right posterior cerebral artery. , 2020, ss.304 - 308. doi: 10.5543/tkda.2019.57070
AMA varol s,sahin i,KUM G,katkat f,OKUYAN E Coronary stent embolism to the right posterior cerebral artery. . 2020; 304 - 308. doi: 10.5543/tkda.2019.57070
Vancouver varol s,sahin i,KUM G,katkat f,OKUYAN E Coronary stent embolism to the right posterior cerebral artery. . 2020; 304 - 308. doi: 10.5543/tkda.2019.57070
IEEE varol s,sahin i,KUM G,katkat f,OKUYAN E "Coronary stent embolism to the right posterior cerebral artery." , ss.304 - 308, 2020. doi: 10.5543/tkda.2019.57070
ISNAD varol, sinan vd. "Coronary stent embolism to the right posterior cerebral artery". (2020), 304-308. https://doi.org/doi: 10.5543/tkda.2019.57070
APA varol s, sahin i, KUM G, katkat f, OKUYAN E (2020). Coronary stent embolism to the right posterior cerebral artery. Türk Kardiyoloji Derneği Arşivi, 48(3), 304 - 308. doi: 10.5543/tkda.2019.57070
Chicago varol sinan,sahin irfan,KUM Gökmen,katkat fahrettin,OKUYAN ERTUGRUL Coronary stent embolism to the right posterior cerebral artery. Türk Kardiyoloji Derneği Arşivi 48, no.3 (2020): 304 - 308. doi: 10.5543/tkda.2019.57070
MLA varol sinan,sahin irfan,KUM Gökmen,katkat fahrettin,OKUYAN ERTUGRUL Coronary stent embolism to the right posterior cerebral artery. Türk Kardiyoloji Derneği Arşivi, vol.48, no.3, 2020, ss.304 - 308. doi: 10.5543/tkda.2019.57070
AMA varol s,sahin i,KUM G,katkat f,OKUYAN E Coronary stent embolism to the right posterior cerebral artery. Türk Kardiyoloji Derneği Arşivi. 2020; 48(3): 304 - 308. doi: 10.5543/tkda.2019.57070
Vancouver varol s,sahin i,KUM G,katkat f,OKUYAN E Coronary stent embolism to the right posterior cerebral artery. Türk Kardiyoloji Derneği Arşivi. 2020; 48(3): 304 - 308. doi: 10.5543/tkda.2019.57070
IEEE varol s,sahin i,KUM G,katkat f,OKUYAN E "Coronary stent embolism to the right posterior cerebral artery." Türk Kardiyoloji Derneği Arşivi, 48, ss.304 - 308, 2020. doi: 10.5543/tkda.2019.57070
ISNAD varol, sinan vd. "Coronary stent embolism to the right posterior cerebral artery". Türk Kardiyoloji Derneği Arşivi 48/3 (2020), 304-308. https://doi.org/doi: 10.5543/tkda.2019.57070