Dual coronary embolization associated with atrial fibrillation: a case report
Background: Thrombotic occlusion of the coronary artery, which succeeds the atherosclerotic plaque
rupture or erosion, gives rise to a major portion of acute myocardial infarction (AMI) incidences.
Nevertheless, coronary embolism is gaining increasing recognition as another important factor contributing
Case presentation: A 72-year-old woman with atrial fibrillation (AF) and diabetes mellitus histories,
presented with chest pain radiating to the left arm and shoulder that began 6 hours prior to admission.
Electrocardiogram revealed AF plus ST-segment elevation in the anterior leads.
Intervention: Patient was first treated with anti-platelet agents (aspirin plus ticagrelor) and atorvastatin.
Emergency coronary angiography depicted multi-site coronary embolization of the left circumflex artery
(LCX) and the left anterior descending artery (LAD). Blood flow was not restored after intracoronary
injection of 600 ug tirofiban. 40 mg recombinant human prourokinase was then administered via aspiration
Outcome: Two weeks later, coronary angiography showed no residual obstructive lesion in the LCX and
LAD with TIMI (thrombolysis in myocardial infarction) 3 flow.
Conclusion: Primary percutaneous coronary intervention is the most effective measure. In the case of
failed blood flow restoration, thrombolytic treatment in both intravenous and intracoronary route should be
Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al. Third universal definition of myocardial infarction. Eur Heart J. 2012;33(20):2551-67.
Thygesen K, Task Force M, Alpert JS, Task Force M, White HD, Task Force M, et al. Universal definition of myocardial infarctionKristian Thygesen, Joseph S. Alpert and Harvey D. White on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. Eur Heart J. 2007;28(20):2525-38.
Shibata T, Kawakami S, Noguchi T, Tanaka T, Asaumi Y, Kanaya T, et al. Prevalence, clinical features, and prognosis of acute myocardial infarction attributable to coronary artery embolism. Circulation. 2015;132(4):241-50.
Chugh SS, Blackshear JL, Shen W-K, Hammill SC, Gersh BJ. Epidemiology and natural history of atrial fibrillation: clinical implications. J Am Coll Cardiol. 2001;37(2):371-8.
Waller BF. Atherosclerotic and nonatherosclerotic coronary artery factors in acute myocardial infarction. Cardiovasc Clin. 1989;20(1):29-104.
Prizel K, Hutchins GM, Bulkley BH. Coronary artery embolism and myocardial infarction: A clinicopathologic study of 55 patients. Ann Intern Med. 1978;88(2):155-61.
Park HS, Park JH, Jeong JO. Intracoronary catheter aspiration can be an adequate option in patients with acute myocardial infarction caused by left atrial myxoma. J Cardiovasc Ultrasound. 2009;17(4):145-7.
Charles RG, Epstein EJ, Holt S, Coulshed N. Coronary embolism in valvular heart disease. Q J Med. 1982;51(202):147-61.
Box LC, Hanak V, Arciniegas JG. Dual coronary emboli in peripartum cardiomyopathy. Tex Heart Inst J. 2004;31(4):442-4.
Kiernan TJ, Flynn AM, Kearney P. Coronary embolism causing myocardial infarction in a patient with mechanical aortic valve prosthesis. Int J Cardiol. 2006;112(2):e14-6.
Hernandez F, Pombo M, Dalmau R, Andreu J, Alonso M, Albarran A, et al. Acute coronary embolism: angiographic diagnosis and treatment with primary angioplasty. Catheter Cardiovasc Interv. 2002;55(4):491-4.
Rifaie O, Nammas W. Coronary air embolism during mitral valvuloplasty. Acta Cardiol. 2011;66(5):665-7.
Braun S, Schrotter H, Reynen K, Schwencke C, Strasser RH. Myocardial infarction as complication of left atrial myxoma. Int J Cardiol. 2005;101(1):115-21.
Copyright (c) 2021 Zesheng Xu, Yonggang Yuan
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain full copyright to their individual works, and publishing rights without restrictions.
In accordance with the Budapest Open Access Initiative, articles published in STEMedicine are freely available "on the public internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from gaining access to the internet itself. The only constraint on reproduction and distribution, and the only role for copyright in this domain, should be to give authors control over the integrity of their work and the right to be properly acknowledged and cited."
Except where otherwise noted, all content on this website is licensed under a Creative Commons Attribution 4.0 License. This license allows for commercial and non-commercial redistribution as well as modifications of the work as long as attribution is given to the authors and STEMedicine as the original publication source, and a link to the article on the STEMedicine website is provided.