Akutni inferiorni infarkt miokarda izazvan embolizacijom distalne prednje descendentne arterije trombom iz glavnog stabla leve koronarne arterije uspešno lečen bez perkutane koronarne intervencije

  • Nemanja Djenić Military Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Branko Milovanović Military Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Radoslav Romanović Military Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade
  • Siniša Stojković University Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Andjelko Hladiš Military Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia
  • Marijan Spasić Military Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia
  • Boris Džudović Military Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia
  • Dragan Dulović Military Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia;
  • Zoran Jović Military Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Slobodan Obradović Military Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP210428017D
Ključne reči: koronarna bolest;, koronarni krvni sudovi;, infarkt miokarda;, antiagregaciona sredstva;, lečenje, ishod

Sažetak


Uvod. Tromboza glavnog stabla leve koronarne arterije (GSLKA) predstavlja retku ali potencijalno smrtonosnu manifestaciju akutnog koronarnog sindroma. Standardni pristup u lečenju takvih bolesnika jeste primarna perkutana koronarna intervencija (pPKI) ili hirurška revaskularizacija miokarda (coronary artery bypass graft surgery). U određenim slučajevima, na osnovu morfološkog izgleda tromba, nalaza i protoka dobijenih metodom koronarne angiografije (KAn), kliničke slike, kao i iskustva kardiologa, jedan od načina lečenja može biti i konzervativni pristup intenzivnom antitrombocitnom terapijom. Prikaz bolesnika. Muškarac star 37 godina primljen je u jedinicu za hitne slučajeve jer je pokazivao znake akutnog infarkta miokarda sa ST elevacijom dijafragmalne lokalizacije. Urađena je hitna KAn tokom koje je pronađen tromb u proksimalnoj trećini GSLKA, bez potpune opstrukcije protoka krvi. Inicijalno, primenjena je dvojna antitrombocitna terapija (tikagrelor i acetilsalicilna kiselina), a u daljoj proceduri odlučeno je da se uvede inhibitor glikoproteinskog IIb/IIIa receptora trombocita (tirofiban) u vidu intrakoronarnog bolusa (0,3 µg/kg), a zatim kao kontinuirana infuzija (0,1 µg/kg/min). Četiri dana kasnije, urađeni su kontrolna KAn i intravaskularna ehokardiografija, nakon čega je odlučeno da se nastavi samo sa konzervativnom terapijom, bez procedure pPKI. Bolesnik je bez tegoba, u dobrom stanju, otpušten na kućno lečenje osmog dana nakon prijema u bolnicu, uz planirano intenzivno praćenje u daljem toku oporavka. Zaključak. U slučaju neopstruktivnih trombocitnih masa bez značajne aterosklerozne stenoze, može se razmotriti modalitet konzervativnog lečenja upotrebom agresivne antitrombocitne terapije.

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Objavljeno
2023/11/02
Broj časopisa
Vol. 80 Br. 10 (2023): Vojnosanitetski pregled
Rubrika
Prikaz bolesnika