Intraprocedural thrombus formation in the left main tract during primary percutaneous coronary intervention

A 67 years old male presented with acute myocardial infarction. Emergency coronary angiography demonstrated subocclusive stenosis in the proximal Left Anterior Descending artery (LAD). Primary Percutaneous Coronary Intervention (PCI) was complicated with intraprocedural thrombosis in the distal Left Main Tract (LMT) following implantation of a stent in the mid LAD. The thrombus was successfully managed with heparin and quadruple antiplatelet therapy (abciximab, aspirin, clopidogrel, and cilostazol) after several attempts of thrombectomy adequate distal flow was achieved. The lesion in the proximal LAD was successfully treated using a kissing stent technique in the second stage.