Successful left gastric artery embolization followed by coronary stenting in a patient with ACS complicated by severe upper gastrointestinal bleeding

Author(s): Marat A. Aripov, Serob A. Manukyan, Mun Yevgeniy and Philip la Fleur

The presence of severe upper gastrointestinal bleeding significantly limits the use of antiplatelet and anticoagulation therapy in patients with Acute Coronary Syndrome (ACS), because of the risks inherent in performing PCI with anticoagulant and antiplatelet agents. A 72-year-old man was diagnosed with the non-ST-elevation acute coronary syndrome (NSTE-ACS) by ECG and clinical signs. We performed urgent coronagraphy, which revealed multivessel lesions of coronary arteries with critical stenosis of the coronary artery. Cardiac surgery with shunting was planned for the following day, but we subsequently observed melena and the patient began vomiting with blood. Gastroscopy was performed and revealed the presence of stomach cancer on the sub cardinal region reaching the body of the stomach. The dilemma of the current case was the combined risk of further cardiovascular morbidity and the risk of bleeding on dual antiplatelet therapy. Embolization of the left gastric artery was performed with the EmbGold Biosphere 500- 700 µm; concomitant use of clopidogrel and aspirin let us perform stenting using drug-eluting Resolute Integrity and Resolute Onyx stents (Medtronic). This case report suggests that gastric artery embolization is possible in patients with ACS, complicated by acute upper gastrointestinal bleeding requiring stenting and dual antiplatelet therapy.