Adjuctive Procedures - Adjuctive Procedures (Thrombectomy, Atherectomy, Special Balloons)
"Beyond the First Episode: MINOCA's Unforeseen Path to Re-infarction and True Obstruction"
Norhaliza Am Haris1, Ahmad Farhan Abdul Hamid1
National Heart Institute, Malaysia1,
Previous ECG during NSTEMI showed T wave inversion at inferior leads. Raised troponin levels, LDL 3.3mmol/L, HbA1C 5%. Echocardiogram showed LVEF 54%, normal valves. Cardiac MRI in May 2023(6 months from index event) revealed findings of previous myocardial infarction involving distal RCA territory with non-obstructed coronary arteries (MINOCA). No evidence of stress induced ischemia and no microvascular dysfunction. He admitted again in June 2023 with ST elevation of the inferoposterior leads. echo.avi
Reinfarction following MINOCA carries high mortality and morbidity to the patient. Aggressive secondary preventive measures is therefore is very crucial after the first event which was likely due to spontaneous thrombolysis following plaque disruption or thrombus formation. Intracoronary imaging like IVUS or OCT helps to identify the mechanisms behind it so that specific therapies can be initiated to treat the underlying cause. Thrombectomy remains the mainstay of treatment of large coronary thrombus. Putting a stent in a ectatic coronary artery with large thrombus burden confers a high risk of reocclusion hence we decided to treat it with anticoagulation and potent antiplatelets.