A 79-year-old man with a past history of myocardial infarction and multiple percutaneous coronary interventions was admitted to our coronary care unit with a non-ST-elevation myocardial infarction. Coronary angiography was performed using a 6-Fr hydrophilic sheath through the right radial artery. The diagnostic procedure revealed a new severe focal lesion in the obtuse marginal artery just distal to a previously implanted stent (Fig. 1a). Hence the operator decided to proceed to percutaneous intervention using a left 3.5 extra backup guiding catheter. While the guiding catheter was passing through the radial artery, the patient reported mild discomfort in the forearm and the operator felt some resistance, although it reached the ascending aorta quite easily. After engaging the guiding catheter into the left main coronary artery, with an adequate aortic pressure curve, the patient developed sudden chest pain, and ST elevation was seen on the electrocardiographic monitor. Subsequent contrast injection revealed a total occlusion of the obtuse marginal artery (Fig. 1b).
a Critical stenosis of the left obtuse marginal artery (white arrow). b Occlusion of the left obtuse marginal artery (white arrow)
What do you think happened and what would you do?
Answer
You will find the answer elsewhere in this issue.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
F.F. Gonçalves, L.F. Seca and J.I. Moreira declare that they have no competing interests.
Caption Electronic Supplementary Material
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Gonçalves, F.F., Seca, L.F. & Moreira, J.I. An unwanted intruder. Neth Heart J 29, 111–112 (2021). https://doi.org/10.1007/s12471-020-01427-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12471-020-01427-9