IJCS | Volume 32, Nº2, May/June 2019

DOI: 10.5935/2359-4802.20190008 297 CASE REPORT International Journal of Cardiovascular Sciences. 2019;32(3)297-301 Mailing Address: Felipe Falcão Rua Isaac Salazar, 102/902. Postal Code: 52060-105, Recife, PE - Brazil. E-mail: felipejaf@gmail.com Coronary Angioplasty with Stent in Woman with Active Vaginal Bleeding Felipe José de Andrade Falcão, 1, 2 F abiano Lima Cantarelli, 2 A line Hofmann Baião, 2 M arco Rivera, 2 Verônica Monteiro, 2 F lavio Roberto Azevedo de Oliveira 2 Universidade de Pernambuco, 1 Garanhuns, PE - Brazil Instituto de Medicina Integral Prof. Fernando Figueira, 2 Recife, PE - Brazil Manuscript received on February 26, 2018, revised manuscript on June 29, 2018, accepted on July 23, 2018. Emb o l i z a t i o n Th e r a p e u t i c ; L e i omy oma ; Uterine Hemorrhage; Woman; Angioplasty; Stent; Hemorrhage/complications. Keywords Abstract Uterine leiomyoma and coronary artery disease are two common diseases in women. However, the association of uterine bleeding caused by leiomyoma with unstable coronary syndrome is not frequent. Here we describe a case of a patient with active vaginal bleeding and unstable angina who underwent a unique approach by performing percutaneous procedures. The report demonstrates that new interventional options can be used to control active bleeding in patients in need of coronary angioplasty. Introduction Percutaneous transluminal coronary angioplasty (PTCA) with stent requires dual antiplatelet therapy with acetylsalicylic acid and a P2Y 12 receptor inhibitor (clopidogrel, ticagrelor or prasugrel). However, this approach increases the risk of bleeding that should always be evaluated since hemorrhagic complications have an adverse impact on prognosis. 1 Patientswithan increased riskof bleedingorwithactive bleeding usually undergo surgical revascularization since they do not require dual antiplatelet therapy. 2 We report a case of a patient with uterine leiomyoma with active vaginal bleeding who underwent, during the same surgical session, coronary angioplastywith stenting and uterine embolization. Case report Female patient, 42 years old, with uterine leiomyoma, reporting chest pain with sweating on moderate exertion and progressive worsening. The patient had a history of hypermenorrhagia and progressive dysmenorrhea, three previous pregnancies with no complications and tubal ligation. Thepatient reportedhypertensionandnon-insulin dependent diabetesmellitus (treatment initiated about five years ago) and no lesions in any other target organs. During the bleeding episode, the patient had chest pain at rest, requiring blood transfusion to stabilize her condition (hemoglobin 7g/dL). No changes in myocardial necrosis markers or electrocardiogramwere observed (unstable angina). Echocardiography showed normal sized heart chambers, left ventricular ejection fraction of 70% and no changes in segmental contractility. Cardiac catheterization revealed 90% stenosis of the medial third of the left anterior descending (LAD). Due to frequent vaginal bleeding wich made the use of dual antiplatelet therapy impossible, myocardial revascularization surgery was performed and a hysterectomy was planned to be done after recovery. The surgery consisted of anastomosis of the left internal thoracic artery (LITA) to the LAD, without extracorporeal circulation, with no complications. On the seventh postoperative day, the patient had severe vaginal bleeding followed by typical chest pain, hypotension and electrocardiogram showing dynamic T-wave changes in the anterior wall. A second cardiac catheterization showed occlusion of the medial third of the LITA, and severe stenosis of the medial third of the LAD. Arteriography of the uterine arteries showed artery hypertrophy, coiling of intraparenchymal branches and tumor blush. At this