A 70-year-old woman, with no traditional cardiovascular risk factor, came to our attention because of a non-ST-segment myocardial infarction. Her cardiac history was uneventful, except the recent onset of episodes of waxing and waning epigastric pain. Of note, 2 weeks earlier, she began therapy with enoxaparin due to the suspicion of deep vein thrombosis. At admission, the patient complained of sharp, persisting pain referred to the epigastrium. Physical examination and routine blood test results were normal. Cardiac enzymes were raised (CK-MB 22.8 ng/ml) and ECG showed diffuse repolarization abnormalities. At echocardiography, mild depression of left ventricle function was found, with hypokinesis of its anterior and lateral walls. Coronary angiography ( Fig. 1 ) revealed a critical stenosis of the ramus intermedius with a high thrombus burden downward the lesion (Panel A), thus prompting for percutaneous revascularization in the same session. After wiring of the culprit vessel, excimer laser angioplasty was performed (Panel B). Thrombus vaporization and underlying plaque debulking were concurrently obtained (Panel C). The intervention was eventually completed with bare metal stenting for stabilization of the lesion. Procedure success was achieved with optimal percutaneous coronary flow and myocardial perfusion (Panel D).
