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Clin. Cardiol. 24, 788 (2001)
This section edited by Edward A. Geiser, M.D.
Jay D. Schlaifer, M.D., William Horgan, M.D., Michael J. Malkowski, M.D.
Department of Cardiology, Allegheny University of the Health Sciences, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
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FIG. 1 Angiogram of the left coronary artery in the anterior-posterior projection. There is a large filling defect consistent with thrombus (large arrow) involving the left main coronary artery, proximal left anterior descending artery, and proximal left circumflex artery. The distal left anterior descending artery is occluded by thrombus (small arrow). |
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FIG. 2 Angiogram of the left coronary artery in the anterior-posterior projection after intracoronary infusion of abciximab via a Dispatch Catheter®. There is significant reduction in thrombus burden in the proximal vessels (large arrow) but the distal left anterior descending artery occlusion persists. |
A 36-year-old female presented to the emergency department with severe chest pressure after two days of intermittent chest pain. Past medical history was remarkable for eight spontaneous abortions. Electrocardiogram was consistent with an acute anterolateral myocardial infarction. She was treated with aspirin and heparin and taken to the catheterization laboratory for emergent coronary angiography and primary angioplasty. Angiography revealed thrombotic occlusion of the distal left anterior descending artery (LAD) and large thrombus burden involving the left main coronary artery (LMCA), proximal LAD, and left circumflex artery (Fig. 1). Abciximab 0.25 mg/kg IV was administered as a 10-min bolus infusion via a Dispatch Catheter® (Scimed, Maple Grove, Minn., USA) positioned in the LMCA and proximal LAD. Repeat angiography after the bolus infusion demonstrated substantial reduction in thrombus burden (Fig. 2) without evidence of distal embolization. There was a concomitant resolution of the patient's chest pain and gradual improvement in the ST-segment elevation after the abciximab bolus. No definitive stenosis was identified angiographically in the proximal segments and therefore adjunctive angioplasty was not performed. Distally in the LAD, attempted angioplasty resulted in no improvement, probably due to the thrombotic nature of the lesion. The patient continued a 12-h infusion of abciximab in addition to IV heparin and aspirin without further angina. Repeat angiography the following day revealed persistently occluded distal LAD but no residual thrombus proximally. The patient was subsequently diagnosed with antiphospholipid antibody syndrome with a positive Hexagonal Lipid Neutralization test and treated with large doses of coumadin to maintain INR range between 3.0–4.0. At 2-year follow-up, she had had no further clinical evidence of myocardial ischemia or arterial thrombosis.
Reference