LMCA thrombosis presenting as inferior wall myocardial infarction successfully treated with intracoronary tenecteplase

CASE STUDY, January 2016, VOL IV ISSUE I, ISSN 2042-4884
10.5083/ejcm.20424884.145 , Cite or Link Using DOI
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Dr Tom Devasia MD DM Professor, Dr Hashir Kareem MD DM Associate Professor, Dr M Sudhakar Rao Registrar MD, Dr Rohith Poondru Reddy Registrar MD, Dr Sravan K Reddy Registrar MD, Dr Rameshwar Reddy M Registrar MD

ABSTRACT

We report a case of 40 year old male who presented with chest pain and diaphoresis. General and systemic examination was unremarkable. Electrocardiogram was suggestive of inferior wall myocardial infarction. Coronary angiogram revealed large thrombus in left main coronary artery. In view of risk of distal embolisation with thrombectomy, intracoronary tenecteplase was administered following which there was complete resolution of thrombus in left main system. A thorough workup of the cause including thrombotic panel (Protein C, Protein S) was carried out and was negative. Patient made a successful recovery and is doing well on follow-up.

LEARNING OBJECTIVES

1. In the case of left main stem thrombosis, intracoronary fibrinolysis can be preferred to aspiration thrombectomy due to the high risk of distal embolisation.

INTRODUCTION

Left main coronary (LMCA) thrombosis in setting of acute myocardial infarction is a rare entity and carries a high mortality. No clear cut guidelines have been described regarding the management of the same. Treatment modalities include emergent bypass grafting (CABG), emergent percutaneous intervention (PCI) and use of intravenous or intracoronary fibrinolysis or glycoprotein IIb/IIIa inhibitors. Very few cases of intracoronary tenecteplase for LMCA thrombosis have been mentioned in literature so far.

Through this case report, we emphasise the importance of intracoronary fibrinolysis for LMCA thrombosis to prevent the risk of distal embolisation with thrombectomy.