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Open Access 11-05-2020 | Image Puzzle – Question

An unwanted intruder

Auteurs: F. F. Gonçalves, L. F. Seca, J. I. Moreira

Gepubliceerd in: Netherlands Heart Journal | Uitgave 2/2021


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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s12471-020-01427-9) contains supplementary material, which is available to authorized users.
A 79-year-old man with a past history of myocardial infarction and multiple percutaneous coronary interventions was admitted to our coronary care unit with a non-ST-elevation myocardial infarction. Coronary angiography was performed using a 6-Fr hydrophilic sheath through the right radial artery. The diagnostic procedure revealed a new severe focal lesion in the obtuse marginal artery just distal to a previously implanted stent (Fig. 1a). Hence the operator decided to proceed to percutaneous intervention using a left 3.5 extra backup guiding catheter. While the guiding catheter was passing through the radial artery, the patient reported mild discomfort in the forearm and the operator felt some resistance, although it reached the ascending aorta quite easily. After engaging the guiding catheter into the left main coronary artery, with an adequate aortic pressure curve, the patient developed sudden chest pain, and ST elevation was seen on the electrocardiographic monitor. Subsequent contrast injection revealed a total occlusion of the obtuse marginal artery (Fig. 1b).
What do you think happened and what would you do?


You will find the answer elsewhere in this issue.

Conflict of interest

F.F. Gonçalves, L.F. Seca and J.I. Moreira declare that they have no competing interests.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by/​4.​0/​.

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Netherlands Heart Journal

Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...


Caption Electronic Supplementary Material

An unwanted intruder
F. F. Gonçalves
L. F. Seca
J. I. Moreira
Bohn Stafleu van Loghum
Gepubliceerd in
Netherlands Heart Journal / Uitgave 2/2021
Print ISSN: 1568-5888
Elektronisch ISSN: 1876-6250

Andere artikelen Uitgave 2/2021

Netherlands Heart Journal 2/2021 Naar de uitgave

Image Puzzle – Answer

An unwanted intruder