A Non-Stenting Approach to Left Main Thrombus in an Oncology Patient with Acute Heart Failure: A Case Report

BACKGROUND Managing acute coronary syndrome in cancer patients poses significant challenges for cardiologists, who often encounter various complications. However, there are multiple therapeutic strategies available. The key lies in identification of the target lesion and early restoration of antegrade blood flow in cases in which it is affected. CASE REPORT We present a case of a 70-year-old man with a medical history of hypertension, type II diabetes mellitus, bioprosthetic aortic valve, coronary artery disease with prior PCI to the LAD, and metastatic prostate cancer who presented with chest pain and shortness of breath. The patient was hemodynamically unstable, with elevated lactates and troponin levels. He was diagnosed with cardiogenic shock secondary to N-STEMI. Coronary angiography revealed a high thrombotic burden at the LM bifurcation, which was managed with balloon angioplasty and medical therapy without stent implantation. Intravascular imaging with IVUS was performed 2 days later, which showed no dissections or significant stenosis. A conservative management strategy was implemented. CONCLUSIONS Cardiogenic shock is a life-threatening complication of N-STEMI, necessitating urgent coronary angiography and immediate revascularization. In certain cases, particularly those involving active malignancy, plain balloon angioplasty combined with optimal medical therapy can be a viable alternative to stent placement. Intravascular imaging assists in making the final decision. Cancer should not be considered a contraindication for invasive treatment in patients presenting with acute coronary syndrome.