Acute Myocardial Infarction during Endovascular Aortic Aneurysm Repair for Abdominal Aortic Aneurysm; a Suspected Case of Kounis Syndrome

Abstract

We report a case of lethal AMI during EVAR for AAA mediated by an anaphylactic reaction. A man of 60s was indicated for EVAR for hostile abdomen due to the previous laparotomy. The operation was uneventful until sudden ST elevation was noted on ECG monitor just before the final aortogram. He rapidly fell into cardiogenic shock with VF. Intraoperative CAG revealed diffuse spasm with broad thrombotic occlusion of both the LAD and LCX. Immediately, successful PCI were done in Seg. 6 in the LAD in vain. This case is presumed to be the first reported instance of Kounis syndrome during EVAR.