Abrupt vessel occlusion during intracoronary intervention: Is this nightmare related to contrast agent?

ALTUN, ARMAGAN; PİRHAN, Osman; YILMAZTEPE, Mustafa; Aktoz, Meryem; Tatli, Ersan; UFACIK, Osman

Abrupt vessel occlusion during intracoronary intervention: Is this nightmare related to contrast agent?

Ersan TATLI, (Trakya Üniversitesi, Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Edirne, Türkiye)

Meryem AKTOZ, (Trakya Üniversitesi, Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Edirne, Türkiye)

Osman UFACIK, (Trakya Üniversitesi, Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Edirne, Türkiye)

Osman PİRHAN, (Trakya Üniversitesi, Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Edirne, Türkiye)

Mustafa YILMAZTEPE, (Trakya Üniversitesi, Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Edirne, Türkiye)

Armağan ALTUN (Trakya Üniversitesi, Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Edirne, Türkiye)

Trakya Üniversitesi Tıp Fakültesi Dergisi

4 1

Yıl: 2008 Cilt: 25 Sayı: 1 Sayfa Aralığı: 68 - 71 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Abrupt vessel occlusion during intracoronary intervention: Is this nightmare related to contrast agent?

Öz:

Kırk altı yaşında, koroner arter hastalığı için risk faktörü olarak hipertansiyon ve aile öyküsü olan erkek hasta akut anterior miyokard infarktüsünün ikinci saati içinde kliniğimize başvurdu. Kurtarıcı perkütan koroner girişim sırasında sol ön inen arterin tam tıkandığı gözlendi. İşlem sırasında kullanılan 150 ml non-iyonik, düşük osmolar kontrast maddenin trombüse yol açarak tam tıkanıklığa neden olabileceği düşünüldü. İntrakoroner bolus tirofiban infüzyonu sonrasında intrakoroner trombozun çözüldüğü görüldü. Lezyon bölgesine stent uygulandı ve TIMI III akımla birlikte çok iyi anjiyografik sonuç elde edildi. Beş ay sonra yapılan kontrol anjiyografide sol ön inen koroner arter tamamen açık idi. Kurtarıcı işlem sırasında gelişen akut koroner tıkanmaların tedavisinde tirofiban infüzyonuyla bareber stentleme tıkanıklığı etkin bir şekilde gidermektedir.

Anahtar Kelime: Kontrast ortamı Trombolitik tedavi Erkek Orta yaşlı Stentler Koroner tromboz Miyokard enfarktüsü

Konular: Genel ve Dahili Tıp

Koroner arter girişimi sırasında ani tıkanma: Bu kabus kontrast maddeyle ilişkili mi?

Öz:

A 46-year-old man with hypertension and family history for coronary artery disease presented to our department within the second hour of acute anterior wall myocardial infarction. During rescue percutaneous transluminal coronary angioplasty, total occlusion occured in the left anterior descending (LAD) coronary artery. A total of 150 ml of non-ionic, low-osmolar contrast agent was used and it was thought that non-ionic contrast media could have induced thrombus formation. After bolus intracoronary tirofiban administration, there was satisfactory resolution of the intracoronary thrombosis. Stent implantation at the lesion site resulted in an excellent angiographic result with a TIMI III flow. At five-month control angiography, the LAD was widely patent. Acute total occlusions during rescue coronary angioplasty can be effectively managed by tirofiban infusion and stenting.

Anahtar Kelime: Thrombolytic Therapy Male Middle Aged Stents Coronary Thrombosis Myocardial Infarction Contrast Media

Konular: Genel ve Dahili Tıp

Belge Türü: Makale Makale Türü: Olgu Sunumu Erişim Türü: Erişime Açık

1) Bhatt DL, Bertrand ME, Berger PB, L'Allier PL, Moussa I, Moses JW, et al. J Meta-analysis of randomized and registry comparisons of ticlopidine with clopidogrel after stenting. Am Coll Cardiol 2002;39:9-14.
2) Popma J, Bhatt DL. Case presentations and discussions. J Invasive Cardiol 2003;15 Suppl B:34B-41B.
3) Haery C, Exaire JE, Bhatt DL, Yadav JS, Franco I, Ellis SG. Use of PercuSurge GuardWire in native coronary arteries during acute myocardial infarction. J Invasive Cardiol 2004;16:152-4.
4) Wöhrle J, Grebe OC, Nusser T, Al-Khayer E, Schaible S, Kochs M, et al. Reduction of major adverse cardiac events with intracoronary compared with intravenous bolus application of abciximab in patients with acute myocardial infarction or unstable angina undergoing coronary angioplasty. Circulation 2003; 107:1840-3.
5) Tan K, Sulke N, Taub N, Sowton E. Clinical and lesion morphologic determinants of coronary angioplasty success and complications: current experience. J Am Coll Cardiol 1995;25:855-65.
6) Lincoff AM, Popma JJ, Ellis SG, Hacker JA, Topol EJ. Abrupt vessel closure complicating coronary angioplasty: clinical, angiographic and therapeutic profile. J Am Coll Cardiol 1992;19:926-35.
7) de Feyter PJ, DeScheerder I, van den Brand M, Laarman G, Suryapranata H, Serruys PW. Emergency stenting for refractory acute coronary artery occlusion during coronary angioplasty. Am J Cardiol 1990; 66:1147-50.
8) Robertson HJ. Blood clot formation in angiographic syringes containing nonionic contrast media. Radiology 1987;162:621-2.
9) Gabriel DA, Jones MR, Reece NS, Boothroyd E, Bashore T. Platelet and fibrin modification by radiographic contrast media. Circ Res 1991;68:881-7.
10) Qureshi NR, den Heijer P, Crijns HJ. Percutaneous coronary angioscopic comparison of thrombus formation during percutaneous coronary angioplasty with ionic and nonionic low osmolality contrast media in unstable angina. Am J Cardiol 1997;80:700-4.
11) Piessens JH, Stammen F, Vrolix MC, Glazier JJ, Benit E, De Geest H, et al. Effects of an ionic versus a nonionic low osmolar contrast agent on the thrombotic complications of coronary angioplasty. Cathet Cardiovasc Diagn 1993;28:99-105.
12) Grines CL, Schreiber TL, Savas V, Jones DE, Zidar FJ, Gangadharan V, et al. A randomized trial of low osmolar ionic versus nonionic contrast media in patients with myocardial infarction or unstable angina undergoing percutaneous transluminal coronary angioplasty. J Am Coll Cardiol 1996;27:1381-6.
13) Rechavia E, Wurzel M. Platelet glycoprotein IIb/IIIa receptor blockade in acute myocardial infarction associated with thrombotic occlusion of the left main coronary artery. Circulation 1998;98:1249-50.
14) Muhlestein JB, Gomez MA, Karagounis LA, Anderson JL. Rescue ReoPro: Acute utilization of abciximab for the dissolution of coronary thrombus developing as a complication of coronary angioplasty. Circulation 1995;92:I-607.

APA	Tatli E, Aktoz M, UFACIK O, PİRHAN O, YILMAZTEPE M, ALTUN A (2008). Abrupt vessel occlusion during intracoronary intervention: Is this nightmare related to contrast agent?. , 68 - 71.
Chicago	Tatli Ersan,Aktoz Meryem,UFACIK Osman,PİRHAN Osman,YILMAZTEPE Mustafa,ALTUN ARMAGAN Abrupt vessel occlusion during intracoronary intervention: Is this nightmare related to contrast agent?. (2008): 68 - 71.
MLA	Tatli Ersan,Aktoz Meryem,UFACIK Osman,PİRHAN Osman,YILMAZTEPE Mustafa,ALTUN ARMAGAN Abrupt vessel occlusion during intracoronary intervention: Is this nightmare related to contrast agent?. , 2008, ss.68 - 71.
AMA	Tatli E,Aktoz M,UFACIK O,PİRHAN O,YILMAZTEPE M,ALTUN A Abrupt vessel occlusion during intracoronary intervention: Is this nightmare related to contrast agent?. . 2008; 68 - 71.
Vancouver	Tatli E,Aktoz M,UFACIK O,PİRHAN O,YILMAZTEPE M,ALTUN A Abrupt vessel occlusion during intracoronary intervention: Is this nightmare related to contrast agent?. . 2008; 68 - 71.
IEEE	Tatli E,Aktoz M,UFACIK O,PİRHAN O,YILMAZTEPE M,ALTUN A "Abrupt vessel occlusion during intracoronary intervention: Is this nightmare related to contrast agent?." , ss.68 - 71, 2008.
ISNAD	Tatli, Ersan vd. "Abrupt vessel occlusion during intracoronary intervention: Is this nightmare related to contrast agent?". (2008), 68-71.

APA	Tatli E, Aktoz M, UFACIK O, PİRHAN O, YILMAZTEPE M, ALTUN A (2008). Abrupt vessel occlusion during intracoronary intervention: Is this nightmare related to contrast agent?. Trakya Üniversitesi Tıp Fakültesi Dergisi, 25(1), 68 - 71.
Chicago	Tatli Ersan,Aktoz Meryem,UFACIK Osman,PİRHAN Osman,YILMAZTEPE Mustafa,ALTUN ARMAGAN Abrupt vessel occlusion during intracoronary intervention: Is this nightmare related to contrast agent?. Trakya Üniversitesi Tıp Fakültesi Dergisi 25, no.1 (2008): 68 - 71.
MLA	Tatli Ersan,Aktoz Meryem,UFACIK Osman,PİRHAN Osman,YILMAZTEPE Mustafa,ALTUN ARMAGAN Abrupt vessel occlusion during intracoronary intervention: Is this nightmare related to contrast agent?. Trakya Üniversitesi Tıp Fakültesi Dergisi, vol.25, no.1, 2008, ss.68 - 71.
AMA	Tatli E,Aktoz M,UFACIK O,PİRHAN O,YILMAZTEPE M,ALTUN A Abrupt vessel occlusion during intracoronary intervention: Is this nightmare related to contrast agent?. Trakya Üniversitesi Tıp Fakültesi Dergisi. 2008; 25(1): 68 - 71.
Vancouver	Tatli E,Aktoz M,UFACIK O,PİRHAN O,YILMAZTEPE M,ALTUN A Abrupt vessel occlusion during intracoronary intervention: Is this nightmare related to contrast agent?. Trakya Üniversitesi Tıp Fakültesi Dergisi. 2008; 25(1): 68 - 71.
IEEE	Tatli E,Aktoz M,UFACIK O,PİRHAN O,YILMAZTEPE M,ALTUN A "Abrupt vessel occlusion during intracoronary intervention: Is this nightmare related to contrast agent?." Trakya Üniversitesi Tıp Fakültesi Dergisi, 25, ss.68 - 71, 2008.
ISNAD	Tatli, Ersan vd. "Abrupt vessel occlusion during intracoronary intervention: Is this nightmare related to contrast agent?". Trakya Üniversitesi Tıp Fakültesi Dergisi 25/1 (2008), 68-71.