Abstract
A 60 year old nonsmoker, nondiabetic gentleman with normal lipid and renal profile presented with acute anterior wall ST elevated myocardial infarction with mild left ventricular systolic dysfunction. He was subjected to transradial coronary angiogram but could not be accomplished from both right and left side as bilateral radial pulses were feeble (Grade 1); we could roll the radial artery bilaterally more than 10 cm from the radial styloid process and patient had pseudo hypertension (Osler’s sign positive), and radial angiogram revealed long segment radial arteriosclerosis(Monckeberg's arteriosclerosis)with heavy calcification 1 (Figure1).It is very rare to see such long segment calcification of radial artery in routine clinical practice. Right brachial coronary angiogram revealed calcified left main coronary artery, long segment calcification of left anterior descending coronary artery (from osteoproximal to distal segment), calcified osteoproximal and mid left circumflex coronary artery, long segment calcification of right coronary artery from osteoproximal to distal segment (porcelain coronaries) (Figure 1) which were successfully revascularized with emergent intravascular lithotripsy (IVL) through right transfemoral approach and we achieved thrombolysis in myocardial infarction (TIMI) III flow with good angiographic result post IVL and stenting with DES. Post percutaneous coronary intervention (PCI), aortic angiogram revealed mild calcification of bilateral iliofemoral segments without much tortuosity. Vasodilation-induced flow reduction in radial arteries was not noted; this might be due to extremely calcified and hard arteriosclerotic arteries. Long segment radial arteriosclerosis with calcification can be an indirect marker of diffuse and heavy calcification of the coronaries. 2