Author + information
- Received February 3, 2015
- Accepted February 12, 2015
- Published online June 1, 2015.
- Massimo Medda, MD∗ (, )
- Francesco Casilli, MD,
- El Mehdi Ghommidh, MD,
- Marta Bande, MD and
- Luigi Inglese, MD
- Emodinamica e Radiologia Interventistica, IRCCS Policlinico San Donato, San Donato Milanese (Milano), Italy
- ↵∗Reprint requests and correspondence:
Dr. Massimo Medda, Emodinamica e Radiologia Interventistica, IRCCS Policlinico San Donato, Piazza Edmondo Malan, 20097 San Donato Milanese (Milano), Italy.
- acute myocardial infarction
- aortic valve decalcification intervention
- coronary embolism
- embolic-protection device filter
- percutaneous coronary intervention
- transradial embolectomy
An 81-year-old woman with severe aortic valve (AV) stenosis symptomatic for effort angina pectoris on exertion (New York Heart Association functional class III) underwent an “AV decalcification procedure” without prosthetic valve implantation. Pre-operative coronary angiography had revealed a saccular aneurysm of the proximal part of the left anterior descending coronary artery (LAD) and a mild diffuse atherosclerosis without significant stenosis. Intraoperative transesophageal echocardiogram showed a good result of the surgical procedure. On the sixth post-operative day, the patient complained of intense typical chest pain, with the 12-lead electrocardiogram showing ST-segment elevation in anterolateral. Coronary angiography showed that the LAD was abruptly and subtotally occluded in the middle part by a material that did not look like thrombus, with Thrombolysis In Myocardial Infarction flow grade 1 to 2 (Figure 1, Online Video 1). We advanced a filter device (Embolic Protection System, Filter Wire EZ, Boston Scientific, Natick, Massachusetts) in the distal part of the LAD to capture the embolized material through the withdrawal of the basket in the “open setting” (Figure 2, Online Videos 2 and 3). Coronary angiography and an intravascular ultrasound study (Eagle Eye Platinum catheter, Volcano Corporation, Rancho Cordova, California) confirmed the complete removal of the embolic material and the absence of intraluminal thrombus also within the large saccular aneurysm (Figure 3, Online Video 4). The patient was discharged on single antiplatelet therapy (acetylsalicylic acid 100 mg) associated with acenocoumarol. Histological examination of the specimen extracted from the LAD documented the presence of calcified material (Figure 4). Coronary artery embolism is an uncommon complication after cardiac valve surgery. The “direct” application of a filter device to remove a solid embolus in coronary vessels may be a safe and effective therapy, as we described, and may be a valuable option to manage this rare complication.
For supplemental videos, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 3, 2015.
- Accepted February 12, 2015.
- American College of Cardiology Foundation