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Number 07-06: Microvascular Obstruction by CMR

Case from: Nathan Mewton, Pierre Croisille, Eric Bonnefoy, Didier Revel, Michel Ovize. Department of Radiology, Hopital Cardio-vasculaire Louis Pradel, 59, boulevard Pinel - 69500 Bron (LYON), France;

Clinical: A 41 year-old man admitted with 3 hours of chest pain with initial thrombolysis (tenecteplase) and salvage angioplasty one hour later.

Angiography: Persistent occlusion of proximal LAD (TIMI 0 flow)

Treatment: Rescue PCI of LAD (distal protection, IIB/IIIA inhibitor abciximab) restored apparently normal TIMI 3 flow, but afterwards there were anterior Q waves and persistent ST elevation. TnT I: 417ng/ml; CK 10,055 UI/l.

Cine CMR: Antero-septal akinesia (without thinning at this stage), severe LV systolic impairment.

Perfusion CMR: Absent first-pass perfusion of the infarct territory.

Contrast CMR: A thin rim of late enhancement surrounding an almost transmural region of no-reflow

Perspective: Massive microvascular obstruction (MVO) at tissue level is here demonstrated by CMR despite apparently normal reflow angiographically (TIMI 3 flow). MVO is a strong predictor of adverse outcome after MI.

Scanner: Philips 1.5T Intera

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