Key result
Deferred OCT-guided revascularization after anticoagulation achieves complete success in LM-LAD bifurcation STEMI.
Why the study?
STEMI is uncommon in young women and may present with features initially suggesting alternative diagnoses, complicating management strategies.
Case Report (n=1)
A deferred, OCT-guided revascularization strategy combined with initial therapeutic anticoagulation is a viable and safe approach for high-thrombus-burden coronary lesions with concurrent LV thrombus.
Supports feasibility of deferred OCT-guided strategy in rare STEMI with LV thrombus; leaves open prospective validation in larger cohorts.
Background & Aims: ST-segment elevation myocardial infarction (STEMI) is uncommon in young women and may present with features that initially suggest an alternative diagnosis. To report a deferred, optical coherence tomography-guided revascularization strategy for a high-thrombus-burden left main-left anterior descending artery bifurcation lesion in a young woman with ST-segment elevation myocardial infarction and a concomitant left ventricular thrombus. Presentation of Case: This case describes a 25-year-old active smoker with no known cardiovascular history presented with prolonged chest pain and diffuse ST-segment elevation with biphasic T waves, initially raising suspicion of acute myocarditis. Echocardiography demonstrated apical akinesia with preserved ejection fraction and a mobile apical thrombus. Coronary angiography with optical coherence tomography (OCT) revealed a severe thrombotic stenosis of the ostial-proximal left anterior descending artery (LAD) extending into the left main (LM) coronary artery, with a distal LAD embolic occlusion. A staged strategy was adopted: therapeutic anticoagulation for one week followed by OCT-guided LM-LAD bifurcation angioplasty, with complete technical and angiographic success (TIMI 3 flow). Aetiological work-up revealed marked hyperhomocysteinaemia; despite a family history suggestive of autoimmune disease, the patient's own thrombophilia and antiphospholipid work-up did not confirm a defined heritable or acquired prothrombotic disorder; only isolated low-titre antinuclear antibodies were detected. Discussion: This case illustrates the practical value of OCT for guiding a deferred, staged revascularization strategy in a high-thrombus-burden LM-LAD bifurcation lesion, and for informing individualised antithrombotic decision-making in the presence of a concomitant left ventricular thrombus. Conclusion: A deferred, OCT-guided strategy allowed safe revascularization of a high-thrombus-burden LM-LAD bifurcation lesion in this young woman, with complete angiographic success. Even with a suggestive family history, an aetiological work-up in a young patient with an unprovoked atherothrombotic event may not confirm a prothrombotic disorder; this does not diminish the value of performing the work-up.
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Bentama et al. (2026) conducted a case report in ST-segment elevation myocardial infarction (STEMI) mimicking myocarditis (n=1). Deferred optical coherence tomography (OCT)-guided revascularization was evaluated on Technical and angiographic success (TIMI 3 flow). A deferred, OCT-guided revascularization strategy after one week of therapeutic anticoagulation achieved complete angiographic success in a young woman with a thrombotic LM-LAD bifurcation STEMI.
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