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A 62 year old man had a postero inferior myocardial infarction with cardiogenic shock followed by cardiac arrest from which he was successfully resuscitated. Coronary angiographic studies at 6 hours after infarc-tion showed a significant eccentric narrowing and an intracoronary thrombus in the mid-portion of the right coronary artery (RCA), with slow distal flow. After intracoronary thrombolysis, a residual tilling defect was shown in the lesion. However, complete perfusion of the RCA was achieved, so coronary angioplasty was not performed. Repeat angiographic studies 42 days later showed a radiolucent line separating the true and false lumen of the vessel and the compression of the true lumen by the false lumen in the mid RCA, and a diagno-sis of primary coronary artery dissection was made. Many examinations showed that coronary revascular-ization was not indicated for the coronary dissection. Under medical treatment, the patient is now alive and well 2 years after infarction.

Primary coronary artery dissection may lead to acute myocardial infarction or sudden death, but cases in which a patient has survived an acute myocardial infarction complicated by cardiac arrest are quite rare. Angiographically several findings are diagnostic for primary coronary artery dissection, but our case in point demonstrates that a coronary dissection is not always indicative of an intracoronary thrombus, espe-cially in the acute phase of a myocardial infarction.


Copyright © 1995, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1200 印刷版ISSN 0452-3458 医学書院

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