Successful Mechanical Thrombectomy Using a Stent-Retriever Device for STEMI of the Left Main Coronary Artery.

BACKGROUND: Left main coronary artery disease causing acute coronary syndrome is associated with high rates of mortality and morbidity. There are no guidelines to address the management of obstructive left main thrombi refractory to standard therapy, with limited data on neurovascular stent retrievers for treating intracoronary thrombus. CASE SUMMARY: A 41-year-old man presented with ST-segment elevation myocardial infarction due to a large distal left main thrombus with downstream embolization. Despite antithrombotic medical therapy and unsuccessful mechanical aspiration, definitive thrombus removal was achieved using the Medtronic Solitaire X with restoration of flow and no complications. DISCUSSION: Guidelines provide limited direction for refractory intracoronary thrombus. Emerging evidence supports neurovascular stent-retrievers as a feasible bailout strategy, though data remain sparse, particularly for left main interventions. TAKE-HOME MESSAGE: When conventional strategies fail, neurovascular stent-retriever thrombectomy may be a safe and effective adjunct for refractory coronary thrombus in acute coronary syndrome, including left main cases.