She LQ, Gao DK, Hong L, Tian Y, Wang HZ, Huang S. Intracoronary thrombolysis combined with drug balloon angioplasty in a young ST-segment elevation myocardial infarction patient: A case report. World J Cardiol 2024; 16(9): 531-541 [PMID: 39351340 DOI: 10.4330/wjc.v16.i9.531]
Corresponding Author of This Article
De-Kui Gao, Chief Doctor, Department of Cardiology, Jiangyou Second People's Hospital, No. 31 Juhui Road, Jiangyou 621701, Sichuan Province, China. 635651229@qq.com
Research Domain of This Article
Emergency Medicine
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Li-Qiong She, Department of Critical Care Medicine, Jiangyou Second People's Hospital, Jiangyou 621701, Sichuan Province, China
De-Kui Gao, Le Hong, Sheng Huang, Department of Cardiology, Jiangyou Second People's Hospital, Jiangyou 621701, Sichuan Province, China
Yin Tian, Hui-Zhen Wang, Department of Interventional Medicine, Jiangyou Second People's Hospital, Jiangyou 621701, Sichuan Province, China
Co-first authors: Li-Qiong She and Le Hong.
Author contributions: She LQ, Gao DK and Hong L contributed to manuscript writing; Gao DK and Hong L contributed to manuscript editing and data analysis; Gao DK, She LQ and Wang HZ contributed to data visualization; Tian Y, Wang HZ and Huang S contributed to data collection; She LQ contributed to conceptualization; all authors have read and agreed to the final version for submission. She LQ and Hong L contributed equally to this work as co-first authors.
Supported byMianyang Health Commission 2019 Scientific Research Encouragement Project, No. 201948.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: De-Kui Gao, Chief Doctor, Department of Cardiology, Jiangyou Second People's Hospital, No. 31 Juhui Road, Jiangyou 621701, Sichuan Province, China. 635651229@qq.com
Received: March 27, 2024 Revised: August 28, 2024 Accepted: September 10, 2024 Published online: September 26, 2024 Processing time: 176 Days and 3.5 Hours
Abstract
BACKGROUND
The combination of acute ST-segment elevation myocardial infarction (STEMI) and gastric ulcers poses a challenge to primary percutaneous coronary intervention (PPCI), particularly for young patients. The role of drug-coated balloons (DCBs) in the treatment of de novo coronary artery lesions in large vessels remains unclear, especially for patients with STEMI. Our strategy is to implement drug balloon angioplasty following the intracoronary administration of low-dose prourokinase and adequate pre-expansion.
CASE SUMMARY
A 54-year-old male patient presented to the emergency department due to chest pain on June 24, 2019. Within the first 3 minutes of the initial assessment in the emergency room, the electrocardiogram (ECG) showed significant changes. There was atrial fibrillation with ST-segment elevation. Subsequently, atrial fibrillation terminated spontaneously and reverted to sinus rhythm. Soon after, the patient experienced syncope. The ECG revealed torsades de pointes ventricular tachycardia. A few seconds later, it returned to sinus rhythm. High-sensitivity tropon in I was normal. The diagnosis was acute STEMI. Emergency coronary angiography revealed subtotal occlusion with thrombus formation in the proximal segment of the left anterior descending artery. Considering the patient's age and history of peptic ulcer disease, after the intracoronary injection of prourokinase, percutaneous transluminal coronary angioplasty and cutting balloon angioplasty were conducted for thorough preconditioning, and paclitaxel drug-eluting balloon angioplasty was performed without any stents, achieving favorable outcomes.
CONCLUSION
A PPCI without stents may be a viable treatment strategy for select patients with STEMI, and further research is warranted.
Core Tip: The focus of this report is the emergency management of a young patient with ST-segment elevation myocardial infarction and a history of gastric ulcers. Coronary angiography revealed near-total occlusion of the proximal left anterior descending artery. Primary percutaneous coronary intervention are likely difficult. After discussion with the patient, our strategy was to inject a novel thrombolytic agent (recombinant human prourokinase) via the intracoronary route to dissolve or clear the local thrombus in the coronary artery. Then, a conventional balloon combined with a cutting balloon is used for adequate pre-expansion. Finally, paclitaxel drug-eluting balloon angioplasty was performed, achieving satisfactory short-term and long-term results.
