Acute myocardial infarction showing total occlusion of right coronary artery and thrombus formation of left anterior descending artery

A 33-year-old Japanese man had an attack of chest pain associated with ST-s egment elevation in the inferolateral leads on his electrocardiogram. Emerg ency coronary angiography showed total obstruction in the mid right coronar y artery (RCA) and a movable thrombus in the proximal left anterior descend ing artery (LAD). We performed emergency percutaneous transluminal coronary angioplasty (PTCA) for the RCA lesion. The operation was successful and we then conducted intracoronary thrombolysis (ICT) with tisokinase 6,400,000 IU for the LAD thrombus. Its size was reduced by ICT. He had an uneventful hospital course. After I month, repeat coronary angiography showed no signi ficant stenosis in the RCA nor thrombus in the LAD. A coronary spasm provoc ation test was performed using acetylcholine. Coronary spasm in the LAD was induced by an intracoronary injection of 100 mug acetylcholine. In this ca se, we observed a unique condition suggesting simultaneous double coronary artery occlusion.