Thrombotic occlusion of the ostial left main coronary artery in a patient with acute coronary syndrome

A 52-year-old male presented with acute coronary syndrome and cardiogenic shock. The patient had no history of previous illnesses or admissions to hospital, specifically he had never received radiotherapy. He was not on any medications and did not abuse illicit substances. He had no history of hypertension, smoking, hypercholesterolaemia, or diabetes. He did not have a family history of premature coronary artery disease. Electrocardiography (ECG) on admission showed ST elevation in lead aVR and V1 (figure 1). Emergent coronary angiogram obtained immediately after placing an intra-aortic balloon pump revealed ostial thrombotic occlusion in the left main coronary artery (LMCA, figure 2). We performed direct coronary angioplasty intervention with the aid of tirofiban (Aggrastat) infusion (figure 3). No residual thrombus and stenosis remained after high pressure balloon dilatation with 3.0x15 balloon at 16 atm, for 30 seconds (figure 4). Inotropic support was maintained with dopamine and intra-aortic balloon pump in the coronary care unit. The patient was asymptomatic one week after the procedure. …