Complete Angiographic Resolution and Ventricular Recovery After Left Main-LAD Thrombotic Occlusion Treated with Thrombus Aspiration Alone: A Three-Year Follow-Up Case Report

Introduction: Acute thrombotic occlusion involving the left main (LM) coronary artery and the proximal left anterior descending (LAD) artery is an uncommon but life-threatening cause of ST-elevation myocardial infarction (STEMI), jeopardizing a large territory of myocardium and carrying a high risk of early mortality. Although routine thrombus aspiration is not recommended for all patients undergoing primary percutaneous coronary intervention (PCI), it may have a role in selected patients with a heavy thrombus burden.

Case presentation: We describe a 57-year-old woman with diabetes mellitus and hypertension who presented with an acute anterior STEMI. Coronary angiography demonstrated a large thrombus occluding the distal LM and extending into the proximal LAD. Manual thrombus aspiration alone restored normal flow without stent implantation. Intravascular ultrasound (IVUS) confirmed complete thrombus resolution with minimal underlying plaque and preserved lumen dimensions. At three-year follow-up, repeat angiography showed normal coronary arteries, and echocardiography demonstrated recovery of left ventricular ejection fraction (EF) from 40% to 50% with normalization of wall motion.

Conclusion: In carefully selected patients with thrombus-rich LM–LAD occlusion and minimal underlying atherosclerosis, thrombus aspiration alone may restore coronary flow and avoid stenting, with durable angiographic and ventricular recovery on long-term follow-up. IVUS provides essential information to guide this strategy.