Therapeutic dilemma – Acute coronary syndrome in the presence of severe mitral stenosis

Coronary artery embolism is an uncommon cause of myocardial infarction. Here we present a case of myocardial infarction in a patient with severe mitral stenosis who was in sinus rhythm at presentation. The patient had complete occlusion of right coronary artery. During percutaneous coronary intervention, because of large thrombus burden the patient developed distal embolism and guide catheter occlusion by the thrombotic material, which was managed successfully.