Case Report

Heart and Vessels

, Volume 28, Issue 6, pp 808-813

First online:

A rare case of myocardial infarction related to diagnostic intravascular ultrasound

  • Ken OtsujiAffiliated withSecond Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health
  • , Fumihiko KamezakiAffiliated withSecond Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Email author 
  • , Shinjo SonodaAffiliated withSecond Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health
  • , Kuninobu KashiyamaAffiliated withSecond Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health
  • , Yoshitaka MuraokaAffiliated withSecond Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health
  • , Yuki TsudaAffiliated withSecond Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health
  • , Masaru ArakiAffiliated withSecond Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health
  • , Masahiro OkazakiAffiliated withSecond Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health
  • , Masaaki TakeuchiAffiliated withSecond Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health
    • , Yutaka OtsujiAffiliated withSecond Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health

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Abstract

A 71-year-old man underwent intracoronary stent implantation for acute inferior myocardial infarction (MI). Immediately after diagnostic intravascular ultrasound (IVUS) at 8 months’ follow-up, an acute occlusion of the sinus node (SN) artery appeared, which developed sinus arrest with junctional escape rhythm. The serum level of high-sensitivity troponin T (TpT) was markedly elevated on the day after the procedure (2.1–32.5 ng/l), which was indicative of MI related to IVUS. Under continuous intravenous infusion of unfractionated heparin, the escape rhythm changed to lower atrial rhythm on the 4th day, and recovered to sinus rhythm on the 14th day. Coronary angiography (CAG) on 15th day showed a recanalization of the SN artery, but optical coherence tomography identified that disrupted plaque and white thrombus still existed in the ostium of the SN artery. The patient was discharged on maintenance anticoagulation therapy. We hypothesized from this case that IVUS-related myocardial injury may exist without clinical problems. Our retrospective investigation showed that the median levels of high-sensitivity TpT in 20 patients who underwent CAG and subsequent diagnostic IVUS significantly increased from 0.6 (interquartile range 0.3–1.1) to 1.6 (0.7–3.6) ng/l (P < 0.05), suggesting that IVUS may induce very low levels of myocardial injury. In conclusion, we experienced a rare case of IVUS-related MI caused by an acute occlusion of the SN artery. This case reaffirms that we should pay more attention to manipulation of IVUS catheters.

Keywords

Complication Intravascular ultrasound Myocardial infarction High-sensitivity troponin T