- Patient initials or identifier number:
-Relevant clinical history and physical exam:
A 49-year-old woman diabetic, hypertensive , and hyperlipidemia presented to the emergency room at our center with sudden onset of severe chest pain of 2 hours duration around 5pm on 19th July 2020. Her ECG and 2D Echocardiogram were consistent with acute anterior wall myocardial infarction. She was given a loading dose of aspirin 325mg and ticagrelor 180 mg and was taken up for primary angioplasty.
-Relevant test results prior to catheterization:
Coronary angiogram revealed 95% narrowing , an ulcerated plaque with grade 3 thrombus in the proximal LAD. Patient underwent Primary Percutaneous Transluminal Coronary Angioplasty (PTCA) and stenting with Xience Expedition 3.0 x 33mm stent to the proximal LAD.
- Relevant catheterization findings:
Final angiogram showed TIMI III flow with good result and ECG showed resolution of ST elevations. Patient was hemodynamically stable until 6 hours post procedure around 1am on 20th July 2020, when she developed anginal chest pain again with profuse sweating, ECG showed ST segment re-elevations in anterior leads. Check angio revealed acute stent thrombosis. Plain Old Balloon Angioplasty (POBA) was done with TIMI III flow with good result and patient was put on Gp IIb/IIIa inhibitor.