Extracorporeal Membrane Oxygenation in Patients With Acute Myocardial Infarction and Critical Multivessel Coronary Artery Disease Involving the Trunk of the Left Coronary Artery; Экстракорпоральная мембранная оксигенация у пациентов с острым инфарктом миокарда и критическим многососудистым поражением коронарного русла с вовлечением ствола левой коронарной артерии

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 lifethreatening complications, especially in cases of socalled “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 venoarterial ECMO in patients with acute myocardial infarction. We present the data of two patients: a 92yearold 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 64yearold 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 followup were favorable. Stenting of critical lesions of the LCA trunk in patients with acute myocardial infarction to reduce the risk of intra and postoperative complications can be effectively and safely performed in conditions of auxiliary venoarterial ECMO (VA ECMO). © 2025 Elsevier B.V., All rights reserved.