Acute myocardial infarction after trauma: potency of percutaneous coronary intervention with transcatheter arterial embolization

A 68-year-old man was brought to the emergency department because of blunt trauma following a motor vehicle accident. Electrocardiogram indicated acute myocardial infarction (AMI) in the posterior and inferior walls. Emergency coronary angiography showed occlusion of the right coronary artery, and we performed coronary stenting with drug-eluting stents and orally administered aspirin and clopidogrel with heparinization. During the intervention, active bleeding from the right chest tubewas noted, and blood pressurewas reduced significantly. Contrast-enhanced computed tomography revealed extravasation from the right intercostal arteries. We performed transcatheter arterial embolization (TAE) to the right intercostal arteries using the same introducer sheath. Following TAE, the patient was stabilized. Treatment for AMI after trauma is controversial but frequently includes percutaneous coronary intervention (PCI) because conservative treatment without revascularization is associated with cardiac complications and reduced ejection fraction. We chose to perform coronary stenting under close monitoring with assistance from trauma surgeons and interventional radiologists in case hemostasis was needed. As a result, bleeding from injuries was exacerbated and successfully treated with TAE from the same introducer sheath. Concurrent use of TAE and PCI for AMI after trauma has not been reported previously, but it was effective. In summary, PCI with interventional radiologists and trauma surgeons on standby may improve the outcomes in patients with AMI after multiple trauma. © 2015 Elsevier Inc. All rights reserved.