Drug-coated balloon-only angioplasty successfully achieved immediate TIMI 3 flow and normal cardiac function at 6 months in a patient with left main acute myocardial infarction and cardiogenic shock.
Case Report (n=1)
Does drug-coated balloon-only angioplasty improve outcomes in a patient with left main coronary artery acute myocardial infarction and cardiogenic shock?
Drug-coated balloon-only angioplasty may represent a viable, life-saving rapid reperfusion strategy for thrombotic left main occlusion in resource-limited settings where safe stenting cannot be guaranteed.
Rationale: Left main coronary artery (LMCA)-related acute myocardial infarction with cardiogenic shock (CS) carries >80% mortality without immediate revascularization. Patient concerns: Thrombolysis often fails in such cases with LMCA and CS, necessitating salvage percutaneous coronary intervention, which typically requires stenting and mechanical circulatory support. Diagnoses: LMCA and CS. Interventions: We report a unique case successfully managed with drug-coated balloon (DCB)-only angioplasty amid resource constraints during the pandemic. This report presents a high-risk case of LMCA acute myocardial infarction with CS following unsuccessful TNK thrombolysis at the local hospital, successfully revascularized with DCB-only angioplasty without stenting, intravascular ultrasound (IVUS), intra-aortic balloon pump, or extracorporeal membrane oxygenation, because of pandemic-related medical resource limitations (IVUS/intra-aortic balloon pump unavailable) and extracorporeal membrane oxygenation not yet implemented at our hospital at that time. Outcomes: Post-procedural TIMI 3 flow was achieved immediately. Postoperatively, the patient’s CS gradually resolved. After 1 month, IVUS performed at a tertiary hospital confirmed no need for further intervention for LMCA. Six months later, cardiac function had recovered to normal. Lessons: This case demonstrates that in resource-limited settings, when safe stent implantation cannot be guaranteed for thrombotic left main occlusion, the DCB-assisted rapid reperfusion strategy may represent a viable, life-saving option. It offers a new approach for primary care hospitals managing such critical emergencies.
Hu et al. (Fri,) conducted a case report in Left main coronary artery acute myocardial infarction with cardiogenic shock (n=1). Drug-coated balloon (DCB)-only angioplasty was evaluated on Post-procedural TIMI flow and clinical recovery. Drug-coated balloon-only angioplasty successfully achieved immediate TIMI 3 flow and normal cardiac function at 6 months in a patient with left main acute myocardial infarction and cardiogenic shock.
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