Multivessel acute coronary thrombosis and occlusion--an unusual cause of cardiogenic shock

A 44-year-old male was admitted with ST-elevation myocardial infarction and cardiogenic shock. Angiography revealed a left anterior descending artery (LAD) as well as right a coronary artery acute thrombotic occlusion and large mobile thrombi in the circumflex artery. He was treated mainly with multivessel thrombus aspiration and intra-aortic balloon insertion. Subsequent intravascular ultrasound a week later revealed mild disease of the LAD only. We suggest that in selected patients with cardiogenic shock, plaque rupture with resultant acute thrombosis in a single coronary artery may lead to low coronary perfusion pressure and consequent multivessel thrombus formation. Thrombus aspiration should be the main therapeutic modality in such unusual cases.