CORONARY - Acute Coronary Syndromes (STEMI, NSTE-ACS)
Left Main Artery Thrombus Treated with Drug Eluting Stent
Ahmed Adel Shaheen1
Patient initials or Identifier Number
Relevant Clinical History and Physical Exam
75y old male known to be diabetic(type2), hypertensive, Heavy smoker and dyslipidemic. Presented by typical chest pain associated with sweeting, and excessive vomiting for 3 hours. In emergency department, patient crushed and his blood pressure became unrecorded. He was promptly transferred to intensive care unit on maximum vasopressors dose. His blood pressure was still unrecorded, however. the patient then has been intubated and kept on mechanical ventilation.
Relevant Test Results Prior to Catheterization
His electrocardiogram showed ST elevation in lead I, AVL, V2-V6 with right bundle branch block and Bedside Echo showed severe anterior, anterolateral, apical and septal hypokinesis and Ejection fraction was 10-15%. His Troponin and lactate were positive but all other labs were normal.
Relevant Catheterization Findings
In emergency department; Patient arrested in ventricular fibrillation immediate cardiopulmonary resuscitation was started, thankfully, the patient restored his circulation after 4 cycles. Intensive care unitI activated cathlab around 3.00 am. In cathlab;Coronary angiography through trans-femoral approach showed; 100% left main thrombus occluded lesion. LM2.mp4
ST-elevation myocardial infarction (STEMI) involving the left main coronary artery (LMCA) has been associated with significant morbidity and mortality. Most studies are limited by small sample sizes. PCI of the ULMCA should be considered as a viable alternative to CABG for selected patients with Ml, including those with ULMCA occlusion and less than Thrombolysis In Myocardial Infarction flow grade 3, cardiogenic shock, persistent ventricular arrhythmias, and significant comorbidities. The higher risk of target vessel revascularization associated with ULMCA PCI compared with CABG is acceptable given the primary need for rapid reperfusion to enhance survival.