Acute coronary syndrome in a young patient with ECG presentation of acute inferior myocardial infarction and acute thrombosis of left main stem coronary artery

Abstract

Introduction. The left main stem coronary artery (MSCA) thrombosis is a rare, but potentially lethal manifestation of the acute coronary syndrome. The standard approach in treating such patients is the primary percutaneous coronary intervention or coronary artery bypass graft surgery. In some cases, depending on the morphological appearance of the thrombus, findings and flow rates assessed on coronary angiography, clinical conditions, and cardiologist?s experiences, another method of treatment may be a conservative approach using the antithrombotic therapy. Case report. A 37 year-old male was admitted to the emergency room with symptoms of an acute myocardial infarction with an ST-elevation in diaphragmal localization. Using emergency coronary angiography we have visualized a thrombus at the ostial and proximal part of the left MSCA, with no complete obstruction of the blood flow. Initially, dual antithrombotic therapy (ticagrelor and acetylsalycilic acid) was applied, and in the further procedure , it was decided to introduce glycoprotein (GP) IIb/IIIa platelet receptor inhibitor (tirofiban) as an intracoronary bolus (0.3 ?g/kg) and later as continuous infusion (0.1 ?g /kg/min). Four days later, a control angiography and intravascular echocardiography were performed, and it was decided to continue the treatment using conservative therapy, without a pPCI procedure. The patient was discharged in a good condition with no signs of illness on the eighth day after hospital admission for home recovery, with planned frequent follow-ups in the future. Conclusion. In the case of non-obstructive thrombotic masses without significant atherosclerotic stenotic lesions, conservative treatment modality with the use of aggressive antithrombotic therapy may be considered.