Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Feb 26, 2020; 12(2): 91-96
Published online Feb 26, 2020. doi: 10.4330/wjc.v12.i2.91
Plaque herniation after stenting the culprit lesion with myocardial bridging in ST elevation myocardial infarction: A case report
Jeffrey Ma, Gregory M Gustafson, Xuming Dai
Jeffrey Ma, Gregory M Gustafson, Xuming Dai, Division of Cardiology, Theresa and Eugene M. Lang Center for Research and Education, New York Presbyterian – Queens Hospital, Flushing, NY 11355, United States
Author contributions: Ma J participated in the care of the patient throughout the hospitalization, collected clinical information, obtained informed consent for the publication of the manuscript and information, reviewed, edited and approved the manuscript; Gustafson GM performed the coronary angiography and primary percutaneous coronary intervention, initiated the discussion about myocardial bridging in STEMI care and plaque herniation; and reviewed, edited and approved the manuscript; Dai X initiated and proposed manuscript concept, participated literature search and review, wrote and revised manuscript as a senior author.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declared no potential conflicts of interest relevant to this manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xuming Dai, FACC, MD, PhD, Attending Doctor, Division of Cardiology, Theresa and Eugene M. Lang Center for Research and Education, New York Presbyterian – Queens Hospital, 56-45 Main Street, Flushing, NY 11355, United States. xud9002@nyp.org
Received: October 9, 2019
Peer-review started: October 9, 2019
First decision: November 19, 2019
Revised: December 12, 2019
Accepted: December 23, 2019
Article in press: December 23, 2019
Published online: February 26, 2020
Processing time: 140 Days and 10.4 Hours
Abstract
BACKGROUND

Myocardial bridging (MB) is increasingly recognized to stimulate atherogenesis, which may contribute to an acute coronary syndrome. Stenting the coronary segment with MB has been recognized to have an increased risk of in-stent restenosis, stent fracture and coronary perforation. The safety and efficacy of stenting the culprit lesion with overlaying MB in ST elevation myocardial infarction (STEMI) as primary reperfusion therapy has not been established.

CASE SUMMARY

We reported a patient who presented with inferior STEMI with a culprit lesion of an acute thrombotic occlusion in the right coronary artery and thrombolysis and thrombin inhibition in myocardial infarction 0 flow. After the stent placement during primary percutaneous coronary intervention, intravascular ultrasound revealed MB overlying the stented segment where heavy atherosclerotic plaque were present. Likely due to the combination of plaque herniation or prolapse caused by MB, as well as local increased inflammation and thrombogenicity, acute stent thrombosis occurred at this region, which led to acute stent failure. The patient required an emergent repeated cardiac catheterization and placing a second layer of stent to enhance the radial strength and reduce the inter-strut space.

CONCLUSION

Plaque herniation or prolapse after stenting a MB segment in STEMI is a potential etiology for acute stent failure.

Keywords: Case report; ST elevation myocardial infarction; Myocardial bridging; Plaque herniation; Plaque prolapse; Intravascular ultrasound; Acute stent thrombosis

Core tip: Stenting the coronary segment with myocardial bridging is known to have increased risks of in-stent restenosis, stent fracture and coronary perforation. Myocardial bridging is also increasingly recognized to be pro-atherosclerotic and potentially involved in acute coronary syndrome, including ST elevation myocardial infarction (STEMI). The safety and efficacy of stenting the culprit lesion with overlying myocardial bridging in STEMI as primary reperfusion therapy has not been established. Here we present a case where plaque herniation or prolapse occurred after stenting a culprit lesion in STEMI, where overlying myocardial bridging was recognized by post-stenting intravascular ultrasound. The plaque herniation at the stented segment with myocardial bridging contributed to acute stent thrombosis which required a second layer of stent deployment. This case highlighted that plaque herniation or plaque prolapse after stenting a segment with myocardial bridging in STEMI is a potential etiology for acute stent failure, and emphasized the important role of intravascular ultrasound in primary percutaneous coronary intervention.