RESUMEN
Homem de 61 anos de idade, com diagnóstico de síndrome mielodisplásica e angina instável foi submetido a angiografia coronariana e implante de stent. O hemograma revelou 40.000/mm³ plaquetas. A angiografia coronariana, precedida por transfusão de plaquetas, revelou obstrução de 80 por cento no óstio da artéria coronariana direita (ACD). Após o uso de clopidogrel 75mg, o paciente foi submetido à nova transfusão de plaquetas e a implante de stent LEKTON 3,0x10mm na lesão da ACD. Não ocorreram sangramentos após as retiradas dos introdutores. Após seis meses, o teste de esforço foi positivo e nova angiografia, sob as mesmas condições anteriores, mostrou reestenose intra-stent. Esse relato sugere que o implante de stent coronariano em pacientes com plaquetopenia é seguro, contanto que se realize a transfusão profilática de plaquetas, embora em longo prazo possa haver reestenose.
Sixty-one-year-old male patient with diagnosis of myelodysplastic syndrome and unstable angina was submitted to coronary angiography and implant of stent. His Blood vell count revealed 40,000 platelets/mm³. Coronary angiography with previous platelet transfusion showed obstruction of 80 percent of the right coronary artery (RCA). Following the administration of clopidogrel, the patient was submitted to another platelet transfusion and stent implantation in the RCA lesion. No bleeding was observed after the introducers removal. After 6 months, treadmill test was positive and new coronary aniography, in the same conditions, showed in-stent restenosis. This case report suggests that coronary stent implantation in patients with thrombocytopenia is a safe procedure, provided that prophylactic platelet transfusion is performed, although late restenosis may occur.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Angioplastia Coronaria con Balón , Angina Inestable/terapia , Síndromes Mielodisplásicos/terapia , Stents , Ticlopidina/análogos & derivados , Angina Inestable/complicaciones , Angina Inestable/diagnóstico , Angiografía Coronaria , Síndromes Mielodisplásicos/complicaciones , Síndromes Mielodisplásicos/diagnóstico , Transfusión de Plaquetas , Inhibidores de Agregación Plaquetaria/uso terapéutico , Resultado del TratamientoRESUMEN
We describe the rare angiographic finding of the right coronary artery arising from the middle portion of the left anterior descending coronary artery in a patient with atherosclerotic coronary artery disease and acute myocardial infarction. This anatomic variation has been previously described only four times in the modern literature.
Relatamos raro achado angiográfico da artéria coronária direita saindo do terço médio da artéria coronária descendente anterior em paciente com doença aterosclerótica coronariana e infarto agudo do miocárdio. Apenas 4 casos desta variação anatômica foram encontrados na literatura
Asunto(s)
Humanos , Masculino , Adulto , Anomalías de los Vasos Coronarios/diagnóstico , Infarto del Miocardio/etiología , Electrocardiografía , Angiografía Coronaria , Anomalías de los Vasos Coronarios/complicacionesRESUMEN
A 43 year-old female patient with angina pectoris and vasospasm demonstrated in the anomalous left circumflex (Cx) and right coronary (RCD) arteries by coronary angiograph. Origin of the left Cx from the RCD is the most common coronary anomaly and generally, is considered to be benign. Nevertheless, myocardial ischemia in patient with this anomaly has been described. To our knowledge, this is the first reported case of coronary vasospasm occurring simultaneously in the anomalous left Cx and RCD arteries. The diagnostic troubles and the potential danger of this association were emphasized.