Case
An 88-year-old woman with a history of critical limb ischemia and a
chief complaint of intermittent chest pain since 3 days was transported
to the emergency room. ST elevation in leads III and aVF was displayed
on an electrocardiogram, and laboratory data showed elevation of
Troponin I (442 pg/mL). Emergency coronary angiography (CAG) through
right radial artery access was performed, but her right axillary artery
was so tortuous that a 6 Fr guide catheter (Profit Plus®️ RU) and Profit
plus 6 Fr JR 4.0 got kinked in it. Therefore, we changed the right
femoral artery access. CAG showed right coronary artery stenosis, and we
placed two drug-eluting stents (Ultimaster 3.5 mm×15 mm, 4.0 mm×15 mm)
in her stenotic lesion.
Her chest pain improved after PCI, but she complained of slight pain in
her right hand during the procedure. We prescribed acetaminophen, but
her symptoms did not resolve. On the next day, the patient felt numbness
and exhibited impaired skilled movement in the right arm. Physical
examination showed nonpalpable right radial and brachial pulses,
indicating advancing ischemia. We performed three-dimensional computed
tomographic angiography, which revealed an obstructive lesion from the
axillary artery to the brachial artery. Therefore, we decided to perform
urgent revascularization (Figure 1,2).