MRN

75y old male known to be diabetic(type2),  hypertensive, Heavy smoker and    dyslipidemic .Presented by typical chest pain  associated with   sweeting , and excessive vomiting for 3 hours. In emergency department , patient crushed and his blood pressure  became unrecorded.He was  promptly   transferred         to intensive care unit on maximum vasopressors dose. His blood pressure was still unrecorded ,however. Patient ,then has been intubated and kept on       mechanical ventilation .

His electrocardiogram showed ST elevation in lead I ,AVL , V2-V6 with right bundle branch block and  Bed side Echo showed sever anterior, anterolateral ,  apical and septal  hypokinesis and Ejection fraction was 10-15% .His Troponin was positive but  all other labs were normal .   

Coronary angiography through trans-femoral  approach showed ; 100% left main thrombus occluded lesion .

In emergency department; patient  arrested  in ventricular fibrillation immediate cardiopulmonary resuscitation   was started, thankfully, patient restored his circulation  after 4 cycles .Intensive care unit  activated cathlab around 3.00 am . In cathlab :Xtra backup  3.5 mm Guiding catheter was engaged into left main coronary artery ,then workhorse  0.0014 wire was secured distally in to ramus  intermedius artery.  Pre dilatation  using  2.00 /15 mm compliant  balloon and inflated at   10 atm and  Then  wiring both left anterior descending artery and left circumflex artery using two  0.0014 workhorse wires was done  .Drug eluting stent 3.00/ 28 mm was deployed from the left main ostium down t to proximal left anterior descending artery at 16 atm , Finally  Proximal optimisation using  3.5 / 15 mm noncompliant  balloon was done at 20 atm with good final result .