Emergency Coronary Stenting for Complete Thrombotic Occlusion of an Unprotected Left Main Coronary Artery in Acute Myocardial Infarction Complicated by Cardiogenic Shock in an Octogenarian Patient

Abstract

This report concerns an 82-year-old white man, who was admitted with cardiogenic shock secondary to an acute anterior myocardial infarction with right bundle branch block requiring an intra-aortic balloon pump for hemodynamic support and mechanical ventilatory support for respiratory distress. An immediate cardiac catheterization with coronary angiography revealed a complete thrombotic occlusion of the left main coronary artery. Prompt stent-supported percutaneous transluminal coronary angioplasty to the occluded left main coronary artery, a critical stenosis of the ostial left anterior descending artery, and the left circumflex coronary artery, allowed for recovery from this life-threatening condition and subsequent discharge from the hospital of this octogenarian patient. It is suggested that in a critical clinical condition with particularly challenging coronary anatomical findings, stent-supported coronary angioplasty can be lifesaving treatment in selected patients with octogenarian status with acute myocardial infarction.

Multiple coronary thrombosis and stent implantation to the subtotally occluded right renal artery in a patient with essential thrombocytosis: A case report with review

“…The left anterior descending artery was reported to be involved in ten patients [12][13][14]16,17,19,21,22,25,26] and the right coronary artery [12,14,17,18] was involved in four patients. The left main coronary artery was involved in three patients [18,23,24]. To our knowledge, our case is the first report with the involvement of the circumflex artery.…”

“…Fewer than 20 cases of essential thrombocytosis with involvement of coronary arteries leading to acute coronary syndromes or myocardial infarction have been reported [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. The association between essential thrombocytosis and coronary artery disease was first reported by Saffitz et al [12].…”

Acute myocardial infarction in a 14-year old boy by thrombotic occlusion of the left main coronary ostium

“…Tariq et al reported the case that was successfully treated by primary stenting for complete thrombotic occlusion of unprotected LMCA in acute myocardial infarction [5]. In our case, the cardiac transplantation could not be avoidable.…”

Left Main Coronary Artery Thrombus: A Case Series with Different Outcomes

“…The reported treatment options for LMCA thrombosis include emergent CABG [2,29,30], emergent LMCA stenting [1,[3][4][5]9,10,[31][32][33][34][35][36][37][38][39], anticoagulation with heparin or glycoprotein IIb/IIIa inhibitors [21,22] and thrombolysis [40][41][42]. Since most patients have hemodynamic compromise, support with IABP is usually initiated [1].…”

“…PCI of LMCA during AMI with [9,10,14,24,[31][32][33][34][35][36][37][38][39] or without [1,[3][4][5]40] LMCA thrombus have been reported. In 24 patients, in-hospital mortality was 43% with stents versus 80% with balloon angioplasty alone ( p = ns), 58% overall and 80% with cardiogenic shock [1].…”