L.W.C.

A 57-year-old female without coronary risk factorswas admitted to the hospital due to 5-month history of intermittent strongchest pain. On admission, her blood pressure was 151/71 mmHg, and her heartrate was 99 bpm. Physical examination revealed a distant heart sound.

An initial ECG showed normal sinus rhythm. An echocardiogram showed a moderate amount of pericardial effusion. Serosanguinous pericardial effusion was drained but acute chest pain was complained of near the end of pericardiocentesis. An immediate ECG showed pronounced ST elevation in the inferior leads but subsided after receiving sublingual nitroglycerin. A CT scan disclosed an anterior mediastinal tumor with abutment to the ascending aorta, encasement and compression to the pulmonary trunk.
Chest CT.avi

Acute coronary syndrome due to coronary arterycompression was suspected. Coronary angiography was performed and revealed 80%stenosis at the ostium of the right coronary artery (RCA) and patent leftcoronary artery.

Radial access was chosen in the procedure. The RCAwas engaged with a 6 Fr JR4 SH guide catheter and the lesion was passed with aSion wire. Intravascular ultrasound (IVUS) showed external compression of theRCA ostium causing lumen encroachment from the 9-12 o'clock direction. Westented the RCA from the ostium to the proximal segment with a 3.5 x 19 mm graftstent and post-dilated with a 3.5 x 15 mm non-compliance balloon at 24atmospheres. After stenting, IVUS was checked and good stent expansion wasconfirmed. There was TIMI 3 flow with a residual 20-30% stenosis in ostial RCA.The patient was symptom-free during the procedure and no acute post-procedurecomplication was noted.

This is a rare case of acute coronary syndrome dueto external coronary artery compression by an anterior mediastinal tumor.CT-guided biopsy confirmed the diagnosis of thymic cancer. We treated thispatient successfully with coronary stenting so that the patient could receivechemotherapy and radiotherapy smoothly.