Abrupt Vessel Occlusion During Intracoronary Intervention: Is This Nightmare Related to Contrast Agent?

A 46-year-old man with hypertension and family history for coronary artery disease presented to our department within the second hour of acute anterior wall myocardial infarction. During rescue percutaneous transluminal coronary angioplasty, total occlusion occured in the left anterior descending (LAD) coronary artery. A total of 150 ml of non-ionic, low-osmolar contrast agent was used and it was thought that non-ionic contrast media could have induced thrombus formation. After bolus intracoronary tirofiban administration, there was satisfactory resolution of the intracoronary thrombosis. Stent implantation at the lesion site resulted in an excellent angiographic result with a TIMI III flow. At five-month control angiography, the LAD was widely patent. Acute total occlusions during rescue coronary angioplasty can be effectively managed by tirofiban infusion and stenting.