Combined double coronary artery thrombosis treated with double primary PCI and spontaneous thrombus resolution

Acute myocardial infarction (AMI) involving two or more culprit lesions at the same time, is an extremely rare event with severe complications, such as congestive heart failure or death. We report a 77-year-old female presenting with persistent chest pain complicated by acute pulmonary edema. ECG demonstrated ST segment elevation in anterolateral leads and the subsequent emergency coronary angiography (CA) via the transradial approach, showed simultaneous total occlusion of left circumflex (LCx) and of a super-dominant 1st OM branch. The latter was ostially occluded and visualized through the right coronary artery opacification. The patient was initially treated with LCx primary PCI, while she had already started on iv tirofibane IIB/IIIA platelet inhibitor, followed by electrocardiographic and clinical improvement and she was transferred stabilized in the Coronary Care Unit. Shortly, due to a new episode of acute dyspnea in combination with ST-segment elevation, the patient reentered the cath lab, were another emergency CA showed spontaneous thrombus resolution in the 1st OM branch revealing a 95% ostial stenosis. The lesion was successfully stented and the patient remained uneventful till hospital exit six days later.