RESUMO
We present a patient who was admitted for carotid endarterectomy due to tight carotid stenosis and recent amaurosis fugax. His medical history included significant coronary artery disease with stable angina pectoris, hypertension with wide pulse pressure, chronic renal failure, and anemia. During preparation for surgery, the patient developed type 2 myocardial infarction with prolonged chest pain, ST depressions on electrocardiogram, and significant troponin elevations. The patient posed a serious clinical dilemma whether to continue with surgery despite the type 2 myocardial infarction or postpone the surgery. We discuss the diagnostic tests and the decision-making processes that guided us in the preoperative period.
Assuntos
Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas/métodos , Infarto do Miocárdio/diagnóstico por imagem , Idoso de 80 Anos ou mais , Estenose das Carótidas/complicações , Tomada de Decisão Clínica , Eletrocardiografia , Humanos , Masculino , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/metabolismo , Assistência Perioperatória , Resultado do Tratamento , Troponina/metabolismoRESUMO
A patient developed hemopericardium shortly after left brachial arterial embolectomy using an embolectomy catheter. Evaluation disclosed evolving pseudoaneurysm of the right coronary artery that was successfully managed by stenting. Misplacement of the embolectomy catheter within the coronary vessel was facilitated by an anomalous origin of the right coronary artery. This complication highlights the importance of correct insertion of the embolectomy catheter using the markers to avoid maladvancement and damage to central vessels.
