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. The optimal revascularization strategy for unprotected left  main coronary disease (ULMCD) is the subject of ongoing debate and patients  with ULMCD still represent a challenge for interventionalist, especially in  the setting of an acute coronary syndome (ACS). Case report. We presented two  cases of percutaneous treatment of ULMCD in the settings of ACS (ST Segment  Myocardial Infarction and Non ST Segment Myocardial Infarction - STEMI and  NSTEMI) in a catheterization laboratory without back-up of cardiosurgical  department. Both patients were hemodynamically unstable with clinical signs  of cardiogenic shock. Coronary angiography revealed left main thromobosis and  using intra-aortic balloon pump as hemodynamic support primary angioplasty  procedures were performed. Immediately after the procedures the patients  hemodynamically improved and remained stable till discharge from hospital.  Conclusion. Percutaneous coronary intervention (PCI) has become the most  common strategy of revascularization in ACS patients with ULMCD and is  generally preferred in patients with multiple comorbidities and/or in very  unstable patients. In cases with no cardiosurgical departments PCI is an  inevitable, bail-out, life saving procedure

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Life-saving percutaneous coronary interventions on the unprotected left main coronary artery in patients with acute coronary syndrome in the catheterization laboratory without cardiosurgical back-up