Double coronary artery thrombosis presenting as acute extensive anterior ST-segment elevation myocardial infarction

Simultaneous thrombosis of more than one coronary artery is an uncommon angiographic finding in acute ST-segment elevation myocardial infarction (STEMI), and usually leads to cardiogenic shock or even sudden cardiac death. We reported a 56-year-old man presenting with persistent chest tightness and ST-segment elevation over precordial leads in electrocardiography (ECG). Emergent coronary angiogram showed total occlusion of both the proximal right coronary artery (RCA) and the proximal left anterior descending artery (LAD). We performed thrombus aspiration and stenting over the LAD with thrombolysis in myocardial infarction (TIMI) III flow to the distal LAD. However, diminishing collateral flow to the distal RCA complicated with complete atrioventricular block (CAVB) and cardiogenic shock developed thereafter. Because distal embolization of the collateral circulation from the LAD to the distal RCA was suspected, thrombus aspiration and stenting over the proximal RCA were performed. After reperfusion of the RCA, the patient's hemodynamic status stabilized and he recovered uneventfully.