Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
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Case Report

Volume 8, Number 6, December 2017, pages 331-335

STEMI Due to Big Ostial Left Main Thrombus Extending Into Aorta: Challenging Situation With No Clear Guidelines

Figures

Figure 1.
Figure 1. ECG showing STE in infero-lateral leads. ECG: electrocardiogram; STE: ST elevation.
Figure 2.
Figure 2. Coronary angiography RAO 8/Caudal 0 view showing big ostial LM thrombus with normal LAD, LCX and RIM arteries. RAO: right anterior oblique; LM: left main; LAD: left anterior descending; LCX: left circumflex; RIM: ramus intermedius artery.
Figure 3.
Figure 3. Coronary angiography RAO 30/Caudal 18 view showing big LM thrombus with normal LAD, LCX and RIM arteries. RAO: right anterior oblique; LM: left main; LAD: left anterior descending; LCX: left circumflex; RIM: ramus intermedius artery.
Figure 4.
Figure 4. Coronary angiography LAO 52/Caudal 15 view showing normal RCA. LAO: left anterior oblique; RCA: right coronary artery.
Figure 5.
Figure 5. IVUS image showing big ostial LM thrombus. IVUS: intravascular ultrasound; LM: left main.
Figure 6.
Figure 6. Intraoperative TEE showing big ostial LM thrombus extending into aorta. TEE: transesophageal echocardiography; LM: left main.
Figure 7.
Figure 7. Histopathological picture from obtained thrombus material.

Table

Table 1. Laboratory Tests at Presentation
 
TestResults
CK: creatine kinase; NT: N-terminal; BNP: brain natriuretic peptide.
CK total (< 190 U/L)920 U/L
Myoglobin (28 - 72 µg/L)600 µg/L
Troponin T high sensitivity (< 14 ng/L)911 ng/L
NT-proBNP (< 85.8 ng/L)18 ng/L
Creatinine (44 - 80 µmol/L)66 µmol/L