Sudden Cardiac Arrest with Acute Myocardial Infarction Induced by Left Subclavian Artery Occlusion in a Patient with Prior Coronary Artery Bypass Surgery
A 70-year-old male presented at the emergency room with SCA after complaining of typical chest pain in December 2011. We had only limited information that he had coronary risk factors including hypertension, diabetes, and smoking, and he underwent CABG 4 years ago in another hospital. After cardiopulmonary resuscitation for 15 minutes, the electrocardiogram showed ST elevation in the anterior leads. We promptly referred the patient to the cathroom for primary percutaneous coronary intervention.\nInitiall physical examination revealed absent pulses in both upper and lower extremities. We perforce performed blind-puncture at left brachial artery, and attempted coronary angiography. However, the 035" hydrophilic soft terumo wire (Terumo, Tokyo, Japan) did not pass the LSCA. Transbrachial peripheral angiography showed total occlusion of LSCA, but the graft from left internal mammary artery (LIMA) to mid left anterior descending artery (LAD) was patent (). After 014" guide wire (Pilot, Abbott, Santa, Clara, CA, USA) passed the lesion, the LSCA was progressively dilated by a 2.0×20 balloon (Lacrosse, Goodman Medical Ireland Ltd., Galway, Ireland) inflated at 16 atm, and a 4.0×20 mm balloon (Lacrosse, Goodman Medical Ireland Ltd., Galway, Ireland) at 18 atm (). A 7.0×24 mm stent (Coroflex Blue, Braun Vascular Systems, Berlin, Germany) was deployed at the LSCA (). Transbrachial coronary angiography showed 3 vessels with CAD presenting significant atherosclerotic stenosis of proximal LAD, big obtuse marginal artery, and mid right coronary artery (). Peripheral angiography showed total occlusion of right common iliac artery and left external iliac artery (). Because the patient's vital signs were unstable, we attempted to insert the intra-aortic balloon pump (IABP) via left brachial artery. The IABP successfully passed the deployed stent of LSCA, and was optimally located in descending thoracic aorta. However, the IABP was not operating properly, and we finally removed the IABP. The patient was stabilized with medical treatment after percutaneous transluminal angioplasty (PTA), but unfortunately had sequela of ischemic brain damage.