ACUTE UPPER LIMB ISCHEMIA COMPLICATING AN INFERIOR STEMI OF UNDETERMINED ONSET

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ID: 330952
2026
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Ranked #318 of 330 articles by views in European heart journal supplements : journal of the European Society of Cardiology

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Abstract
Abstract Background Acute upper limb ischemia is an uncommon but potentially limb-threatening complication of ST-elevation myocardial infarction (STEMI). The prothrombotic state associated with acute coronary thrombosis, endothelial injury, and systemic inflammation may predispose to peripheral arterial embolization or in-situ thrombosis, even in the absence of overt cardiac thrombus. Case Illustration A 45-year-old woman presented with chest pain of undetermined onset. Electrocardiography demonstrated complete atrioventricular block, rate 32 bpm, and inferior ST-segment elevation, consistent with inferior STEMI. She underwent PPCI with temporary pacemaker insertion via femoral access. Coronary angiography revealed two-vessel disease with a thrombotic culprit lesion in the distal RCA, treated with a drug-eluting stent (Promus Premier 2.25 × 32 mm, 11–14 atm), achieving TIMI III flow. Post-procedurally, she developed left arm pain over the brachium, coldness from the cubital region to the hand, and variable oxygen saturation (51%-86%). Duplex ultrasonography demonstrated preserved proximal flow but thrombotic occlusion of the distal brachial, radial, and ulnar arteries. Transthoracic echocardiography revealed inferior wall hypokinesia, preserved LVEF (58.8%), and reduced RV systolic function (TAPSE 10 mm. Emergent surgical thrombectomy using a 4F Fogarty catheter evacuated three thrombi (15 cm thrombus from the ulnar artery, 5 cm thrombus from the radial artery, and 12 cm thrombus from the brachial artery) and restored distal perfusion. Oxygen saturation recovered to above 98% in all fingers. Conclusion Rapid diagnosis of the limb-threatening condition and coordinated multidisciplinary management are vital in optimizing patient outcomes. Prompt surgical embolectomy was limb-saving.Figure 1.(a) Coronary angiography showed 90% stenosis in the distal RCA; (b) Coronary angiography post stenting in the distal RCA; (c) Duplex ultrasonography demonstrated thrombus in the distal brachialis artery; (d) Duplex ultrasonography demonstrated thrombus in the ulnar artery.
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Authors A S Prawara, E L Yolanda, F Tandri, D Y Kurniawan, Y Herry
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Journal European heart journal supplements : journal of the European Society of Cardiology
Year 2026
DOI
10.1093/eurheartjsupp/suag119.026
URL
https://doi.org/10.1093/eurheartjsupp/suag119.026
Keywords Keywords not found

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