Angiogram of the month Complex percutaneous coronary intervention of left main coronary artery in patient with acute myocardial infarction complicated with cardiogenic shock

Abstract

A case report of succesful complex primary percutaneous coronary intervention (PCI) of left main coronary artery (LMCA) in 75-years old patient with anterolateral acute myocardial infarction is presented. At admission patient was found in cardiogenic shock, with arterial blood pressure 85/60. Echocardiography revealed diffuse LV contraction disorders with ejection fraction 25% as well as echocardiographicaly significant mitral regurgitation. Urgent coronarography showed tight stenosis of distal LMCA with obvious thrombus and significant lesions in ostium of left anterior descendent (LAD) and circumflex artery (CX). Due to high risk of coronary artery bypass graft operation patient was qualified for urgent PCI. After insertion of intraaortic counterpulsation (IABP) and initiation of abxicimab infusion, complex PCI of LMCA, LAD and CX was performed. Coronary stent was implanted to LCA, covering also ostial and proximal LAD, than baloon inflation was performed in ostium of CX. At the end of procedure simultaneous inflation in LMCA/LAD and CX was performed (kissing technique). Patient’s status after PCI stayed stable, on 11. day of hospitalisation patient was discharged.