Abstract

A 28 years old male admitted with anginal type of chest pain for 4 hours. Pain was left sided and radiating to jaw, and present even during rest. Patient was known case of Hyper Homocysteinemia on vitamin B12 and folic acid supplementation. Patient also had history of cerebral venous thrombosis in 2019, from then he was taking Warfarin and under regular follow up. On reviewing the records , the prothrombin time and INR (international normalized ratio) was however sub therapeutic recently. ECG was taken, which showed ST elevation in Lead I and a VL , suggestive of a high lateral wall myocardial infarction. Patient was taken up for primary angioplasty .Coronary angiogram showed total thrombotic occlusion of proximal Left anterior descending artery. LAD was wired and Balloon dilatation of the lesion was done. Post procedure LAD had TIMI grade IV thrombus. Thrombus aspiration was done followed by intracoronary streptokinase as the thrombus load was not reducing even after aspiration with aspiration catheters. Despite adequate measures, post procedure Thrombus burden was grade 4 and only TIMI II flow was established. Patient was hemodynamically stable. He was started on tirofiban infusion for 18 hours and managed in coronary ICU. Post procedure check angiogram was repeated after 48 hours which showed TIMI III flow and thrombus was absent. Pt was discharged with Antiplatelets and anticoagulant and was advised to review after 1 month. Later he was followed up at 3 months , in functional class 1 and on optimum regular drugs

Description