A 6-Fr guiding catheter (Judkins-Left 4.0, Profit Goodtec, Gifu, Japan) was inserted into the left coronary artery. After coronary angiography, an additional 5000 IU of heparin was administered and we performed primary percutaneous coronary intervention. There were no stenotic lesions in the right coronary artery or left circumflex artery. ![]() Coronary angiography showed total occlusion with thrombus at the proximal site of the left anterior descending artery (LAD) (Fig. After insertion of the sheath, 5000 IU of heparin was administered through the sheath. A 6-Fr, 25-cm-long sheath was inserted into the right femoral artery. We immediately moved him to the angiography room to perform coronary angiography. The patient received 162 mg of aspirin and 20 mg of prasugrel in the emergency room. He was diagnosed with acute antero-septal myocardial infarction. There was no clear evidence of valvular heart disease on admission. Impaired contractility, especially in the antero-septal wall. Bedside transthoracic echocardiography revealed a slightly dilated left ventricle with A blood test showed a slightly elevated serum troponin-T level (0.138 ng/mL), creatine phosphokinase level (212 U/L), and brain natriuretic peptide level (21.9 pg/mL). Chest X-ray showed expansion of the cardiothoracic ratio and pulmonary congestion. However, electrocardiography showed abnormal Q waves in leads V1–V3, ST elevation in leads V2–V4, I, and aVL and ST depression in leads II, III, and aVF. When he arrived at our hospital, only approximately 2 h had passed since the onset of his symptoms. He had no history of coronary risk factors, except for a smoking habit, and no medication on arrival. ![]() The GuideLiner catheter (Japan Lifeline, Tokyo,
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