# Dual Coronary Artery Thrombosis: An Unforeseen Angiographic Encounter

## TL;DR

A 42-year-old man presented with rare dual coronary artery thrombosis and multiple complications, requiring complex interventions and long-term follow-up.

## Contribution

This case report highlights the rare occurrence of dual coronary artery thrombosis and its management challenges.

## Key findings

- The patient had complete thrombotic occlusions in the LAD and RCA, successfully treated with DES.
- The patient developed cardiogenic shock and septic shock from Fusobacterium periodonticum bacteremia.
- The patient required an IABP and later oral warfarin for ongoing complications.

## Abstract

Acute myocardial infarction (AMI) frequently involves single-vessel coronary artery disease, but simultaneous thrombosis in multiple coronary arteries is a rare and challenging clinical scenario. We report the case of a 42-year-old Southeast Asian male with a six-month history of hypertension controlled by a single antihypertensive agent, presenting to the emergency department with central chest pain radiating to the back. The initial electrocardiography (ECG) showed ST elevation in the inferior leads. Primary percutaneous coronary intervention (PCI) via the right femoral approach revealed complete thrombotic occlusions in the left anterior descending (LAD) and right coronary artery (RCA). Drug-eluting stents (DES) were deployed, restoring thrombolysis in myocardial infarction (TIMI) III flow. Despite initial hemodynamic stability, the patient experienced cardiogenic shock (CS), necessitating a relook angiogram that confirmed patent stents and identified an additional stenosis in the first diagonal branch (D1). An intra-aortic balloon pump (IABP) was inserted. The patient’s course was complicated by recurrent CS, septic shock secondary to Fusobacterium periodonticum bacteremia, acute kidney injury, multiple supraventricular arrhythmias (SVTs), and partial thrombosis of the right radial artery leading to dry gangrene of the right index and thumb fingers. He was eventually discharged on oral warfarin for radial artery thrombosis and paroxysmal atrial fibrillation with follow-up care with vascular surgery.