Clinical Research in Cardiology

, Volume 106, Issue 3, pp 230–233 | Cite as

Comprehensive endovascular treatment of multiple arterial emboli involving LIMA graft, distal aorta and upper and lower extremities in a patient with subacute cerebral hemorrhage

  • Nicolas LangwieserEmail author
  • Karl-Ludwig Laugwitz
  • Tareq Ibrahim
Letter to the Editors


A 64-year-old diabetic female with atrial fibrillation and prior coronary bypass surgery was admitted with cardiogenic shock due to acute anterior ST-elevation myocardial infarction (STEMI). Additionally, she suffered from critical ischemia of both lower and upper left extremities. Seven days ago, she had presented at an external hospital with new-onset right-sided hemianopia and hemiparesis due to left central lobe hemorrhage. Phenprocoumon which the patient took because of persistent atrial fibrillation had been discontinued and prolonged INR had been reversed by inactivated prothrombin-concentrate complex and vitamin K administration. External CT scan performed shortly after onset of acute chest pain and critical ischemia had revealed a floating left atrial appendage thrombus with consequential embolic occlusion of the LIMA graft, the distal aorta (Fig.  1a, b), the superior mesenteric artery (SMA) and the left subclavian artery (SA).


Subclavian Artery Critical Limb Ischemia Mechanical Thrombectomy Distal Aorta Critical Ischemia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Compliance with ethical standards

Conflict of interest


Supplementary material

392_2016_1050_MOESM1_ESM.wmv (3.7 mb)
Movie 1: Angiography showing embolic occlusion of distal aorta and right CIA (WMV 3788 kb)
392_2016_1050_MOESM2_ESM.wmv (654 kb)
Movie 2: Angiography after thrombectomy of distal aorta and right CIA (WMV 653 kb)
392_2016_1050_MOESM3_ESM.wmv (3.6 mb)
Movie 3: Angiography showing occlusion of the LIMA graft to the LAD as well as of the distal left SA (WMV 3666 kb)
392_2016_1050_MOESM4_ESM.wmv (7.3 mb)
Movie 4: Retrieving maneuver by positioning of a filter device into the distal LIMA graft segment and forward pushing of a slightly inflated 3.0x20mm coronary balloon (WMV 7510 kb)
392_2016_1050_MOESM5_ESM.wmv (3.6 mb)
Movie 5: Angiography showing reestablishment of LIMA flow (WMV 3681 kb)
392_2016_1050_MOESM6_ESM.wmv (5.2 mb)
Movie 6: Angiography after thrombectomy of left SA (WMV 5294 kb)
392_2016_1050_MOESM7_ESM.wmv (2.4 mb)
Movie 7: Angiography of SMA showing a total occlusion but present collaterals via the pancreaticoduodenal arteries (WMV 2438 kb)
392_2016_1050_MOESM8_ESM.wmv (819 kb)
Movie 8: Angiography after thrombectomy of left CIA (WMV 819 kb)
392_2016_1050_MOESM9_ESM.wmv (119 kb)
Movie 9: Angiography showing embolic occlusion of right distal PA (WMV 119 kb)
392_2016_1050_MOESM10_ESM.wmv (3.5 mb)
Movie 10: Angiography after thrombectomy of right distal PA (WMV 3538 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Nicolas Langwieser
    • 1
    Email author
  • Karl-Ludwig Laugwitz
    • 1
    • 2
  • Tareq Ibrahim
    • 1
  1. 1.Medizinische Klinik und Poliklinik, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
  2. 2.DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart AllianceMunichGermany

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