Timely Revascularisation and Non-vitamin K Oral Anticoagulant (NOAC) Therapy Resulting in Resolution of Left Ventricular Apical Thrombus in a Young Female With Stumpless Left Anterior Descending Artery ST-Elevation Myocardial Infarction (LAD STEMI)

Left ventricular (LV) thrombus is an uncommon but high-risk complication of acute anterior ST-elevation myocardial infarction (STEMI), particularly in young patients with large infarcts, which is an uncommon finding in the modern PCI era. Its management becomes more challenging when the culprit artery presents as a stumpless occlusion of the left anterior descending artery (LAD). A 30-year-old female presented with angina (Class IIIB) and anterior wall STEMI. Echocardiography revealed a severely hypokinetic apical septal region with a large LV clot but preserved basal function and overall ejection fraction. Coronary angiography demonstrated a stumpless occlusion of the LAD. Percutaneous coronary intervention (PCI) was performed via radial route using a 6F Judkins Left guiding catheter (Cordis, USA). A Sion Blue wire (Asahi Intecc, Japan) was parked in the distal ramus for support; a Fielder XT wire (Asahi Intecc, Japan) over a Finecross microcatheter (Terumo, Japan) successfully crossed the lesion. Sequential pre-dilatation with Mini Trek balloons (Abbott Vascular, USA) was followed by deployment of a 3.0 × 24 mm Xience drug-eluting stent (Abbott Vascular, USA). The final angiogram showed Thrombolysis in Myocardial Infarction (TIMI) grade III flow. The patient was discharged on triple therapy (aspirin, clopidogrel, rivaroxaban). At two-month follow-up, echocardiography and cardiac MRI confirmed complete resolution of LV clot. This case illustrates that revascularisation of the LAD not only restored perfusion but also improved regional wall motion, thereby reducing stasis and facilitating clot resolution when combined with anticoagulation. This synergistic effect highlights the importance of timely PCI and non-vitamin K oral anticoagulant (NOAC) therapy in preventing embolic complications in young STEMI patients with LV thrombus.