Key result
Low-molecular-weight dextran during OCT triggers Kounis syndrome with triple-vessel ischaemia requiring angioplasty and IABP.
Why the study?
Kounis syndrome can present with different variants causing acute coronary syndrome, but cases involving all variants sequentially are rare and not well documented.
Case Report (n=1)
Low-molecular-weight dextran used during OCT can induce severe Kounis syndrome presenting as triple-vessel ischaemia, requiring prompt recognition and mechanical circulatory support.
Documents all Kounis variants sequentially in one patient; extends phenotypic spectrum but leaves open mechanistic and therapeutic implications.
Background: Kounis syndrome (KS) is an acute coronary syndrome (ACS) induced by allergic reactions. Currently, there are three variants of KS based on the mechanism and onset of ACS. We report a rare case of KS, wherein ACS was caused by all KS variants. Case summary: A 68-year-old man with a history of percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction of the left anterior descending artery 16 days ago underwent a staged PCI for the mid-left circumflex artery (LCx) stenosis under optical coherence tomography (OCT) guidance using low-molecular-weight dextran (LMWD). During OCT examination, the LMWD induced an anaphylactic reaction. The patient was immediately administered medications to manage the anaphylaxis; however, he complained of chest discomfort. Coronary angiography and subsequent intravascular ultrasound revealed a newly developed coronary thrombus in the proximal LCx. Furthermore, coronary spasm or multiple stent thromboses occurred sequentially in all coronary arteries, resulting in triple-vessel coronary artery ischaemia. Balloon angioplasty was performed under intra-aortic balloon pumping, which could rescue the patient. The patient was discharged without any complications 11 days post-KS, under a 7-day anti-histamine regimen. No further cardiovascular events had occurred by 1-year follow-up. Discussion: This case documented the clinical course of KS caused by LMWD, wherein all KS variants occurred sequentially. Early recognition of KS and appropriate management with anaphylaxis medication and balloon angioplasty under mechanical circulatory support effectively prevent vascular morbidity. Interventionalists should be aware of this rare and serious complication of PCI.
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Yamamoto et al. (2022) conducted a case report in Kounis syndrome (n=1). Low-molecular-weight dextran (LMWD) was evaluated on Cardiovascular events at 1-year follow-up. Low-molecular-weight dextran administration during OCT induced Kounis syndrome with triple-vessel coronary ischaemia, which was successfully managed with balloon angioplasty and IABP.
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