A case of acute myocardial infarction due to left main coronary artery occlusion: Case report.
Left main coronary artery (LMCA)-related acute myocardial infarction with cardiogenic shock (CS) carries >80% mortality without immediate revascularization.
Thrombolysis often fails in such cases with LMCA and CS, necessitating salvage percutaneous coronary intervention, which typically requires stenting and mechanical circulatory support.
LMCA and CS.
We report a unique case successfully managed with drug-coated balloon (DCB)-only angioplasty amid resource constraints during the pandemic. This report presents a high-risk case of LMCA acute myocardial infarction with CS following unsuccessful TNK thrombolysis at the local hospital, successfully revascularized with DCB-only angioplasty without stenting, intravascular ultrasound (IVUS), intra-aortic balloon pump, or extracorporeal membrane oxygenation, because of pandemic-related medical resource limitations (IVUS/intra-aortic balloon pump unavailable) and extracorporeal membrane oxygenation not yet implemented at our hospital at that time.
Post-procedural TIMI 3 flow was achieved immediately. Postoperatively, the patient's CS gradually resolved. After 1 month, IVUS performed at a tertiary hospital confirmed no need for further intervention for LMCA. Six months later, cardiac function had recovered to normal.
This case demonstrates that in resource-limited settings, when safe stent implantation cannot be guaranteed for thrombotic left main occlusion, the DCB-assisted rapid reperfusion strategy may represent a viable, life-saving option. It offers a new approach for primary care hospitals managing such critical emergencies.
Thrombolysis often fails in such cases with LMCA and CS, necessitating salvage percutaneous coronary intervention, which typically requires stenting and mechanical circulatory support.
LMCA and CS.
We report a unique case successfully managed with drug-coated balloon (DCB)-only angioplasty amid resource constraints during the pandemic. This report presents a high-risk case of LMCA acute myocardial infarction with CS following unsuccessful TNK thrombolysis at the local hospital, successfully revascularized with DCB-only angioplasty without stenting, intravascular ultrasound (IVUS), intra-aortic balloon pump, or extracorporeal membrane oxygenation, because of pandemic-related medical resource limitations (IVUS/intra-aortic balloon pump unavailable) and extracorporeal membrane oxygenation not yet implemented at our hospital at that time.
Post-procedural TIMI 3 flow was achieved immediately. Postoperatively, the patient's CS gradually resolved. After 1 month, IVUS performed at a tertiary hospital confirmed no need for further intervention for LMCA. Six months later, cardiac function had recovered to normal.
This case demonstrates that in resource-limited settings, when safe stent implantation cannot be guaranteed for thrombotic left main occlusion, the DCB-assisted rapid reperfusion strategy may represent a viable, life-saving option. It offers a new approach for primary care hospitals managing such critical emergencies.