Recurrent Vasospastic Myocardial Infarctions and Hand Necrosis

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Reference

Recurrent Vasospastic Myocardial Infarctions and Hand Necrosis

REY, Florian, et al.

REY, Florian, et al . Recurrent Vasospastic Myocardial Infarctions and Hand Necrosis. JACC:

Cardiovascular Interventions , 2017, vol. 10, no. 2, p. 198-199

PMID : 28040441

DOI : 10.1016/j.jcin.2016.10.007

Available at:

http://archive-ouverte.unige.ch/unige:112496

Disclaimer: layout of this document may differ from the published version.

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IMAGES IN INTERVENTION

Recurrent Vasospastic Myocardial Infarctions and Hand Necrosis

Florian Rey, MD,^aMarco Roffi, MD,^aCindy Bouvet, MD,^bRomain Bréguet, MD,^c Peter Jandus, MD,^dFabio Rigamonti, MD^a

A

Primary percutaneous coronary intervention performed via the right radial artery showed an ostial thrombotic subocclusion of the left anterior descend- ing artery (Figure 1A, black arrow) successfully treated with 2 drug-eluting stents under abciximab perfusion.

Two days later, the patient developed an inferior ST- segment elevation myocardial infarction and the repeated percutaneous coronary intervention via the same vascular access revealed a subocclusion of the previously normal mid–right coronary artery (Figure 1B, black arrow). Intravascular optical coher- ence tomography confirmed the angiographic suspi- cion of focal vasospasm (Figure 1C), showing a concentric narrowing without atherosclerosis, dissec- tion, or thrombus. After ineffective intracoronary nitroglycerin and verapamil injection, balloon angio- plasty without stenting permitted the resolution of

spasm and the alleviation of symptoms. Although drug tests were negative, the patient admitted occasional consumption of cocaine and methylamphetamine. He was discharged on oral calcium-channel blocker and dual antiplatelet therapy and the cardiac rehabilitation was uneventful.

Three months later he developed severe right hand ischemia due to extensive spastic and throm- botic occlusions of the forearm and finger arteries (Figure 1D, black arrows) refractory to vasodilators, fibrinolytic agents, and endovascular revasculariza- tion. Despite fasciotomy (Figure 1E), transradial amputation was required due to extensive necrosis.

The vascular histology showed an intimal mono- nuclear infiltration. A cocaine-associated throm- boangiitis obliterans was retained asfinal diagnosis.

As showed in our case, the cocaine-derived car- diovascular risks are present not only in the con- sumption period but could occur weeks or months later and should be considered as risk factors for dramatic outcomes.

From the^aDivision of Cardiology, Geneva University Hospitals, Geneva, Switzerland; ^bDivision of Hand Surgery, Geneva University Hospitals, Geneva, Switzerland;^cDivision of Radiology, Geneva University Hospitals, Geneva, Switzerland; and the

dDivision of Immunology and Allergy, Geneva University Hospitals, Geneva, Switzerland. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Manuscript received September 25, 2016; accepted October 6, 2016.

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REPRINT REQUESTS AND CORRESPONDENCE: Dr.

Florian Rey, Geneva University Hospitals, Division of Cardiology, Department of Internal Medicine Spe- cialties, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland. E-mail:fl[email protected].

KEY WORDS cocaine, hand necrosis, thromboangiitis obliterans, vasospastic angina

FIGURE 1 Images

(A, black arrow)Ostial thrombotic subocclusion of the left anterior descending artery.(B, black arrow)Subocclusion of the previously normal mid–right coronary artery.(C)Intravascular optical coherence tomography confirmed the angiographic suspicion of focal vasospasm.

(D, black arrows)Extensive spastic and thrombotic occlusions of the forearm andfinger arteries.(E)Fasciotomy of the forearm.

J A C C : C A R D I O V A S C U L A R I N T E R V E N T I O N S V O L . 1 0 , N O . 2 , 2 0 1 7 Reyet al.

J A N U A R Y 2 3 , 2 0 1 7 : 1 9 8–9 Recurrent Vasospastic Episodes

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