Cardiogenic Shock due to Complete Thrombotic Occlusion of the Left Main Coronary Ostium in a Young Female

(A) Thrombus extraction with the X-Sizer catheter system in AP view. (B) Final coronary angiography showed TIMI flow grade 1 in AP view.
(A) Aortography in LAO view showed complete thrombotic occlusion of the left main coronary ostium. (B) Engagement of the left coronary ostium using an Extra Back Up guiding catheter in LAO caudal view.
Author(s): 

Angel Sanchez-Recalde, MD, Luis Calvo Orbe, MD, Guillermo Galeote, MD

Cardiogenic shock complicating acute myocardial infarction is associated with high mortality.1,2 Early recognition and coronary revascularization are crucial to improve its poor prognosis. Successful early reperfusion of the infarct-related coronary artery, while maintaining integrity of the downstream microvasculature, limits ongoing necrosis, salvages myocardium, and may prevent the development of cardiogenic shock.3
In this report we present an unusual case of a patient with acute thrombosis of the left main artery who reached the hospital in cardiogenic shock and underwent emergency percutaneous revascularization. The patient was initially treated with inotropic pharmacological support and intra-aortic balloon counterpulsation. Despite using antithrombotic and antiplatelet therapy, including abciximab, and specific devices to remove thrombus, embolization of thrombus occurred distally with the development of the no-reflow phenomenon. The patient died within a few hours. The management of cardiogenic shock complicating myocardial infarction and intracoronary thrombus is discussed, with an emphasis on the utility of thrombectomy devices.



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