Iatrogenic Left Main Coronary Artery Thrombosis During Percutaneous Coronary Intervention

The patient was admitted to our clinic with the diagnosis of unstable angina pectoris. In the coronary angiography, two stenoses (proxismal 90%, distol 60%) in the circumflex artery (CX) were seen. Left anterior descending (LAD) and right coronary arteries were normal. In another session, coronary balloon angioplasty was performed for the CX lesions after which a residual stenosis was detected and stent implantation was decided. Unfortunately, it was not possible to cross the proximal lesion with the 3,0X18 mm stent. Immediately, after pulling back the stent, the patient had severe chest pain. Angiography revealed a thrombotic sub-total occlusion of left main coronary artery (LMCA). During the stent implantation to the LMCA lesion , the thrombus moved distally into the circumflex artery possibly by the movement of the guide wire, leaving the LMCA totally free of thrombus. Accompanied by immediate relief of chest pain, ECG demonstrated at least 80% resolving in the ST segment elevations. The proximal lesion in CX artery was stented and successful angioplasty was performed for distal lesion afterwards, resulting a TIMI III flow. The patient was completely symptomfree in the follow-up period, and control angiography 1 month later revealed a patent stent in CX beside normal LAD, LMCA and right coronary artery. An extremely rare, iatrogenic, subtotal left main coronary artery thrombotic stenosis in a patient who had undergone prior PTCA-stenting of the left circumflex artery was discussed in the light of the literature. (Türk Kardiyol Dern Arş 2004; 32: 197-200)