Extracorporeal Membrane Oxygenation in Patients With Acute Myocardial Infarction and Critical Multivessel Coronary Artery Disease Involving the Trunk of the Left Coronary Artery

Critical coronary stenosis involving the trunk of the left coronary artery (LCA) is one of the most severe factors of coronary artery disease, especially in cases of acute myocardial infarction. The lesion of the LCA trunk, often detected by coronary angiography, is the reason for the refusal of stenting due to the high risk of life-threatening complications, especially in cases of so-called “unprotected” stem lesion (in the presence of occlusion of the right coronary artery). In this case, an emergency operation of direct myocardial revascularization using the coronary artery bypass grafting is preferable. However, in the absence of the possibility of emergency coronary artery bypass grafting and/or prohibitive risks of its performance, percutaneous coronary intervention (PCI) under extracorporeal membrane oxygenation (ECMO) may become the method of choice for the treatment of acute myocardial infarction in this category of patients.

This article presents two successful clinical cases of stenting of left coronary artery trunk stenosis (one of which is unprotected) with a transition to the anterior interventricular artery (AIVA) under veno-arterial ECMO in patients with acute myocardial infarction.

We present the data of two patients: a 92-year-old patient with recurrent myocardial infarction, LCA trunk stenosis up to 75%, AIVA stenosis from the mouth to 95%, and chronic occlusion of the RCA, and a 64-year-old patient with acute myocardial infarction, stenosis in the terminal segment of the left coronary artery by 90% with transition to the mouth of the left circumflex coronary artery and the AIVA.

The early postoperative period in both patients was uneventful, and the first six months of follow-up were favorable. Stenting of critical lesions of the LCA trunk in patients with acute myocardial infarction to reduce the risk of intraand postoperative complications can be effectively and safely performed in conditions of auxiliary veno-arterial ECMO (VA ECMO).

1. Lindstrom SJ, Pellegrino VA, Butt WW. Extracorporeal membrane oxygenation. Med J Aust. 2009;191(3):178–182. PMID: 19645652 https://doi.org/10.5694/j.1326-5377.2009.tb02735.x

2. Koutouzis M, Kolsrud O, Albertsson P, Matejka G, Grip L, Kjellman U. Percutaneous coronary intervention facilitated by extracorporeal membrane oxygenation support in a patient with cardiogenic shock. Hellenic J Cardiol. 2010;51(3):271–274. PMID: 20515862

3. Rossiyskoe obshchestvo spetsialistov po ekstrakorporal’noy membrannoy oksigenatsii. Statistika Ro-sEKMO. (In Russ.). Available at: https://xn--j1aeg1d.xn--p1ai/registr/statistika?ysclid=ly69jz27ap958135749 [Accessed May 28, 2025]

4. Piccolo R, Guistino G, Mehran R, Windecker S. Stable coronary artery disease: revascularization and invasive strategies. Lancet. 2015;386(9994):702–713. PMID: 26334162 https://doi.org/10.1016/S0140-6736(15)61220-X

5. Kornelyuk RA, Vereshchagin IE, Shukevich DL, Ganyukov VI. Mechanical circulatory support in high-risk percutaneous coronary intervention. Kompleksnye problemy serdechno-sosudistykh zabolevaniy. 2018;7(4S):54–65. (In Russ.). https://doi.org/10.17802/2306-1278-2018-7-4S-54-65

6. Kornelyuk RA. Organ protection and prevention of polyorgan insufficiency during high-risk percutaneous coronary intervention by using extracorporal membrane oxygenation. Kompleksnye problemy serdechno-sosudistykh zabolevaniy. 2021;10(2S):27–31. (In Russ.). https://doi.org/10.17802/2306-1278-2021-10-2S-27-31

7. Bazylev VV, Evdokimov ME, Pantiukhina MA, Morozov ZA. Artificial circulation in high-risk percutaneous coronary interventions. Angiologiya i sosudistaya khirurgiya. Zhurnal im. akad. A.V. Pokrovskogo. 2016;22(3):112–119. (In Russ.)

8. Ganiukov VI, Popov VA, Shukevich DL, Evtushenko SA, Khaes BL. Transcutaneous coronary intervention accompanied by biventricular circulatory support and combined with extracorporeal membranous oxygenation. Angiologiya i sosudistaya khirurgiya. Zhurnal im. akad. A.V. Pokrovskogo. 2013;19(1):137–141. (In Russ.)

9. Koutouzis M, Kolsrud O, Albertsson P, Matejka G, Grip L, Kjellman U. Percutaneous coronary intervention facilitated by extracorporeal membrane oxygenation support in a patient with cardiogenic shock. Hellenic J Cardiol. 2010;51(3):271–274. PMID: 20515862

10. Arlt M, Philipp A, Voelkel S, Schopka S, Husser O, Hengstenberg C, et al. Early experiences with miniaturized extracorporeal life-support in the catheterization laboratory. Eur J Cardiothorac Surg. 2012;42(5):858–863. PMID: 22555310 https://doi.org/10.1093/ejcts/ezs176

11. Chen JS, Ko WJ, Yu HY, Lai LP, Huang SC, Chi NH, et al. Analysis of the outcome for patients experiencing myocardial infarction and cardiopulmonary resuscitation refractory to conventional therapies necessitating extracorporeal life support rescue. Crit Care Med. 2006;34(4):950–957. PMID: 16484889 https://doi.org/10.1097/01.CCM.0000206103.35460.1F

12. Ricciardi MJ, Moscucci M, Knight BP, Zivin A, Bartlett RH, Bates ER. Emergency extracorporeal membrane oxygenation (ECMO)-supported percutaneous coronary interventions in the fibrillating heart. Catheter Cardiovasc Interv. 1999;48(4):402–405. PMID: 10559824 https://doi.org/10.1002/(sici)1522-726x(199912)48:4<402::aid-ccd17>3.0.co;2-3

13. Shammas NW, Roberts S, Early G. Extracorporeal membrane oxygenation for unprotected left main stenting in a patient with totally occluded right coronary artery and severe left ventricular dysfunction. J Invasive Cardiol. 2002;14(12):756–759. PMID: 12454340

14. Vanzetto G, Akret C, Bach V, Barone G, Durand M, Chavanon O, et al. [Percutaneous extracorporeal life support in acute severe hemodynamic collapses: single centre experience in 100 consecutive patients]. Can J Cardiol. 2009;25(6):e179–186. PMID: 19536387 https://doi.org/10.1016/s0828-282x(09)70093-5

15. Yamauchi T, Masai T, Takeda K, Kainuma S, Sawa Y. Percutaneous cardiopulmonary support after acute myocardial infarction at the left main trunk. Ann Thorac Cardiovasc Surg. 2009;15(2):93–97. PMID: 19471222