Korean Circ J.  2014 Nov;44(6):429-433. 10.4070/kcj.2014.44.6.429.

Acute ST Elevated Myocardial Injury due to Coronary Thrombosis during Thoracic Endovascular Aortic Repair in Patient with Protein S Deficiency

• Kim TH
• Oh YS
• Eom MY
• Jung YL
• Cho HA
• Choi W
• Shim WH

• KMID: 2223860
• DOI: http://doi.org/10.4070/kcj.2014.44.6.429

Abstract

A 71-year-old woman who had suffered from pulmonary thromboembolism with deep vein thrombosis for 12 years presented the hospital with a huge thoracic aortic aneurysm. During thoracic endovascular therapy, she had a sudden coronary artery occlusion without having organized stenosis or plaque rupture even under the dual antiplatelet treatment and heparinization. She turned out to be having a protein S deficiency. A procedure related thrombotic adverse event in patient with protein S deficiency is very rare, so we report a case with literature review.

Keyword

Protein S deficiency; Endovascular procedures; Coronary thrombosis; Aortic aneurysm, thoracic

MeSH Terms

Aged
Aortic Aneurysm, Thoracic
Constriction, Pathologic
Coronary Thrombosis*
Coronary Vessels
Endovascular Procedures
Female
Heparin
Humans
Protein S Deficiency*
Pulmonary Embolism
Rupture
Venous Thrombosis
Heparin

Figure

• 

  Fig. 1 Pre-procedural aorta CT of presented patient. A: axial CT image shows the huge aneurysm (11 cm of diameter) containing the thrombus. B: reconstructed CT image shows the huge aneurysm containing the mural thrombus and the contrast leakage is seen inside the aneurysm as well. C: axial CT image shows the organized thrombi at the left main pulmonary artery.

• 

  Fig. 2 Baseline and the event polygraphic records show the 3 limb leads ECG and the pulse pressure at the right common femoral artery sheath. A: baseline ECG shows 70 beats per minute of heart rate without significant ST height difference and blood pressure is approximately 110/60 mm Hg. B: an ECG at the time of chest pain indicates newly developed ST elevation at avF limb lead compared to the baseline ECG with 45 beats per minute of heart rate and the blood pressure is approximately 80/50 mm Hg. ECG: electrocardiography.

• 

  Fig. 3 Right coronary artery angiography before and after the thrombus aspiration. A: right coronary angiography shows the mobile multiple thrombi inside of the vessels and the TIMI grade 1 of blood flow. B: right coronary angiography after the thrombus aspiration shows no organic stenosis or remnant thrombi inside the vessel and the TIMI grade 4 of blood flow is restored. TIMI: Thrombolysis in Myocardial Infarction.

• 

  Fig. 4 A pig-tail aortogram and CT angiography after stent-graft insertion. A: a aortogram shows the good position of stent-graft without any kind of leakage. B: a CT angiography taken before discharge shows complete coverage of aneurysm.

Reference

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