Acute coronary syndrome of the left main coronary artery caused by a huge floating thrombus in the ascending aorta: a case report of intravascular ultrasound effectiveness

Abstract Background Left main coronary artery (LMCA)–acute coronary syndrome (ACS) is a rare complication of a floating thrombus in the ascending aorta. However, diagnosing the aetiology of LMCA–ACS during an emergency situation is challenging. We present a rare case of LMCA–ACS caused by a large thrombus in the ascending aorta, confirmed by intravascular ultrasound (IVUS). Case summary A 90-year-old woman presented to the emergency department complaining of chest pain and syncope. On admission, her electrocardiogram showed normal sinus rhythm and a complete right bundle branch block with significant ST depression in the V3–V6 leads; hence, ACS was suspected. The first emergency angiogram of the left coronary artery showed filling defect in the proximal ascending aorta. IVUS revealed a large thrombus in the ascending aorta. The thrombus extended from the ascending aorta to the proximal left anterior descending coronary artery. IVUS confirmed that there was no dissection of the coronary artery or the proximal ascending aorta. Based on the IVUS findings, this case was diagnosed as ACS of the LMCA caused by a floating thrombus in the ascending aorta. Discussion This rare case of LMCA–ACS caused by a thrombus in the ascending aorta was confirmed by IVUS, which can be a useful imaging tool for diagnosing morphological abnormalities during emergencies.

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TCTAP C-043 Intravascular Ultrasound-Guided Percutaneous Coronary Intervention of Isolated Critical Ostial Stenosis of Unprotected Left Main Coronary Artery in Acute Coronary Syndrome

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2018.03.239 ◽

2018 ◽

Vol 71 (16) ◽

pp. S110-S111

Author(s):

Satej Janorkar

Keyword(s):

Percutaneous Coronary Intervention ◽

Acute Coronary Syndrome ◽

Coronary Artery ◽

Intravascular Ultrasound ◽

Left Main Coronary Artery ◽

Coronary Intervention ◽

Ultrasound Guided ◽

Left Main ◽

Coronary Syndrome ◽

Percutaneous Coronary

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Abstract 13152: Do Survivors of Acute Coronary Syndrome Due to Unprotected Left Main Coronary Artery Occlusion Treated With Extracorporeal Membrane Oxygenation Have Higher Mortality in Chronic Phase?

Circulation ◽

10.1161/circ.142.suppl_3.13152 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Haruko Shiota ◽

Eisuke Kagawa ◽

Masaya Kato ◽

Noboru Oda ◽

Eiji Kunita ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Artery ◽

Extracorporeal Membrane Oxygenation ◽

Acute Phase ◽

Cardiac Failure ◽

Left Main Coronary Artery ◽

Chronic Phase ◽

Circulatory Support ◽

Left Main ◽

Coronary Syndrome

Introduction: Mortality in patients with acute coronary syndrome (ACS) due to unprotected left main coronary artery (LMA) occlusion is high. Extracorporeal membrane oxygenation (ECMO) could rapidly provide circulatory support. Hypothesis: This study aimed to verify the hypotheses that the patient who required circulatory support with ECMO in acute phase of LMA-ACS had greater cardiac function deterioration and had higher mortality in the chronic phase than those who did not require ECMO. Methods: Patients with LMA-ACS who underwent percutaneous coronary revascularization between 2000 and 2020 were enrolled in this study. The patients were divided into two groups based on whether or not they received ECMO. Thirty-day (acute phase) and 30-day to 6-year (chronic phase) survival curves were constructed by Kaplan-Meier method. The cause of death in acute and chronic phase were examined. Results: Among the 85 study patients, 23 (27%) were in the ECMO-group. Median age was younger in the ECMO-group (65 y [57 - 72] vs. 73 y [69 - 83], p < 0.01), and male sex (67% vs. 63%) were similar in ECMO group and non-ECMO groups respectively. The prevalence of ST elevation myocardial infarction (STEMI), non-STEMI, unstable angina were 52%, 48%, and 0% vs. 15%, 42%, and 44% in the ECMO group and non-ECMO group, respectively. The 30-day mortality was significantly higher in ECMO group (61% vs. 15%, p < 0.01); however, the 30-day to 6-year mortality was similar between the two groups (41% vs. 33%, p = 0.59) (Figure). The cause of death in the acute phase were cardiac failure (79% and 67%) and those in chronic phase were cardiac failure (50% and 25%), malignancy (0% and 13%), and infection (50% and 36%). Conclusions: The mortality in chronic phase in LMA-ACS patients who survived up to 30 days were similar in ECMO group and non-ECMO group. Moreover the patients whose cardiac function deteriorated severely and required ECMO in acute phase had similar prognosis to those that did not require ECMO.

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