Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 2010 , Vol 1, Issue 2
A Rare Complication of Primary Percutaneous Coronary Intervention: Total Occlusion of The Adjacent Coronary Artery To Culprit Lesion
Şevket Görgülü1, Tuğrul Norgaz1, Mehmet Ergelen2
1Acıbadem Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, İstanbul, Turkiye
2Dr Siyami Ersek Göğüs Kalp Ve Damar Cerrahisi Eğitim Ve Araştırma Hastanesi, Kardiyoloji, İstanbul, Türkiye
Recently, distal embolization of thrombus and plaque debris, as assessed by angiography, has been identified as one of the major drawback of primary PCI in the setting of ST elevation myocardial infarction (STEMI), limiting myocardial reperfusion and leading to larger myocardial damage and worse prognosis. However, proximal embolization can occur as a rare event in patients undergoing primary PCI. In this manuscript, we presented two total occlusion cases which occured due to proximal embolization of successful primary PCI.

There are certain measures that can be taken for distal embolization of a thrombus during primary PCI such as using both intracoronary thrombectomy and distal protection devices. Since this measures may avoid only distal embolization, it would have been insufficient in our cases. However, two measures might be helpful to avoid this complication: one of them is that, the balloon inflation should cover the proximal part where the cut off part begins and the other is the avoidance of balloon inflation beyond its nominal pressure. Keywords : Primary Percutaneous Intervention, Thrombus, Embolization