Total left main coronary artery occlusion in a female patient after AVSD surgical repair in childhood as a cause of non ST elevation myocardial infarction

A case of a 51-year-old woman with symptoms of non-ST-segment elevation acute coronary syndrome and concomitant atrial flutter is presented. Patient underwent atrioventricular septal defect repair in childhood. Coronary angiography showed total occlusion of left main coronary artery and massive collateral network originating from right coronary artery supplying entire left coronary artery. Ablation of atrial flutter had been performed and patient was subsequently submitted to mitral valve replacement, tricuspid valvuloplasty and coronary artery bypass grafting. The potential causes of left main occlusion are in this case discussed.     

Total occlusion of the left main and proximal right coronary artery: Case report and review of the literature

Chronic total left main coronary artery occlusion at angiography is very rare, and there are only four cases reported with concomitant total right coronary artery occlusion. We describe a case of total left main and proximal right coronary artery occlusion and review the clinical and angiographic characteristics of this condition which represents the most severe form of coronary artery disease compatible with life. © 1996 Wiley-Liss, Inc.     

Chronic effort-induced angina as presentation of a totally occluded left main coronary artery: a case report and review

In this report, the case of a 40-year-old patient with chronic total occlusion of the left main coronary artery is discussed. Total occlusion of the left main coronary artery is a rare finding at coronary angiography. When present, patients most often have extensive collateral circulation from the right coronary artery. The mainstay of treatment is surgical with coronary artery bypass grafting.     

Bail-Out stenting for left main coronary artery occlusion following diagnostic angiography

We report a case of acute left main coronary artery occlusion treated with stenting of the left main artery. The patient had a severe ostial left main stenosis and after diagnostic coronary angiography developed a total occlusion of the left main artery with life threatening hemodynamic consequences. Stenting of the unprotected left main coronary artery was successfully performed as a salvage procedure.     

Minor ST-segment deviations followed by tall T waves in precordial leads caused by acute left main coronary artery occlusion:A case report

A 53-year-old male with chest pain complicated with cardiogenic shock was presented to the emergency department. The electrocardiogram showed features of acute myocardial infarction due to left main coronary artery occlusion,and minor ST-segment deviations followed by tall T waves in precordial leads with concomitant left anterior fascicular block. Emergency coronary angiogram revealed left main coronary artery complete occlusion without collateral circulation. Percutaneous intervention of the left main coronary artery was then carried out. The ECG features of a left main occlusion were discussed with this case report.[S Chin J Cardiol 2019;20(3):197-200]     

Mechanical emergency recanalization of the left main coronary artery

Acute occlusion of the left main coronary artery is normally fatal. According to the literature, only a few cases have been treated by intracoronary thrombolysis; the prolonged period of ischemia, however, resulted in severe left ventricular dysfunction and numerous complications. Therefore, effort should be directed to recanalize the left main coronary artery within the shortest possible interval. We followed this approach in a case of acute occlusion of a subtotal stenosis of the left main coronary artery which could be mechanically reopened and dilated within a few minutes. The intervention resulted in immediate reversal of profound cardiogenic shock and complete restoration of normal left ventricular function. At hospital discharge, the patient was asymptomatic with a negative bicycle stress test. Immediate mechanical recanalization and angioplasty appear to be a feasible approach in life-threatening coronary occlusion.     

Percutaneous stenting of chronic total occlusion of unprotected left main coronary artery

Chronic total occlusion of the left main coronary artery is very rare. We report a case in which a totally occluded, unprotected distal left main coronary artery was successfully revascularized percutaneously, establishing normal flow in the left main, left anterior descending and left circumflex coronary arteries.     

The power of collateral circulation: a case of asymptomatic chronic total occlusion of the left main coronary artery

Total occlusion of the left main coronary artery predominantly presents with recurrent angina or myocardial infarction. Long-term survival and myocardial function depends on the well-developed right to left collaterals. We report a case of a 46-year-old man who was referred because of incidental finding of low ejection fraction during work-up for syncope 5 months prior. The patient denied any recurrence or any other symptom after that episode and claimed an unchanged exercise capacity. He had hypertension, hyperlipidemia, and history of 15-pack/year smoking. Except for class II morbid obesity, he had completely normal vital signs, physical examination, and lab tests on admission. The echocardiogram was suggestive of previous anterior wall myocardial infarction and demonstrated a low left ventricle ejection fraction with diffuse hypokinesis of the left ventricle. The patient underwent cardiac catheterization, which revealed total occlusion of the left main coronary artery, dominant right coronary artery with a 95% stenosis in the proximal segment, and collaterals from the right to the left coronary arteries. The patient was immediately referred for coronary artery bypass surgery. This case demonstrates the power of collateral circulation in protecting the patient from symptoms and death despite total occlusion of the left main coronary artery and severe stenosis of the proximal right coronary artery.     

Angor with occlusion of the left main coronary artery treated with angioplasty

The occlusion of the left main coronary artery is rare and generally fatal. However, some subjects do survive. The two conditions necessary for survival appear to be the existence of a dominant right coronary artery and above all a rapidly functional left-right collaterality. The time lapse between occlusion and the introduction of an efficient collateral system is fundamental to patient survival. If the time lapse is too long, there is a risk of myocardial infarction, often complicated by cardiogenic shock, with a poor prognosis even after deocclusion. In this study, the case is reported of a patient with left main coronary artery occlusion presenting as unstable angor without an increase in enzymatic levels, and with a totally functional left-right collaterality. Deocclusion angioplasty was successfully performed. Finally, the short- and medium-term results of left main coronary artery angioplasty have been discussed.     

Unusual combination of total occlusion of left main coronary artery and heart failure with pulmonary hemosiderosis: case report

A case of total occlusion of the left main coronary artery, congestive heart failure, and pulmonary hemosiderosis in a 54-year-old man is reported. Cardiac catheterization showed total occlusion of the left main coronary artery, subtotal occlusion of the right coronary artery, severely deranged hemodynamics, and an akinetic left ventricle except for a hypokinetic posterobasal segment. A radionuclide left ventricular performance study revealed an ejection fraction of 0.16 with diffuse biventricular hypokinesis and dilatation. Despite all the risk factors, the patient underwent a total of six saphenous vein grafts without perioperative or immediate postoperative complications.     

Acute coronary syndrome without ST segment elevation in a 78 year-old woman caused by critical proximal right coronary artery stenosis with concomitant chronic total occlusion of left main coronary artery

Total occlusion of the left main coronary artery is a rare finding at coronary angiography. When present, patients most often have extensive collateral circulation from the right coronary artery. The mainstay of treatment is surgical with coronary artery bypass grafting. We present a case of a 78 year-old woman admitted to our department with two days history of nonspecific, abdominal pain. Her coronarography revealed chronic total occlusion of left main with concomitant critical, proximal right coronary artery stenosis.     

Left main coronary artery aneurysm with chronic total occlusion of both left coronary arteries in a young athlete

Aneurysms of the left main coronary arteries are found in 0.1% of angiograms. This case involves an athlete with a left main coronary artery aneurysm, which was combined with chronic total occlusion of the proximal left anterior descending and proximal left circumflex coronary arteries. The extraordinary clinical presentation in this patient may be associated with good coronary collaterals, which may have developed in the patient in response to chronic total occlusion of the coronary artery by the aneurysm, and repeat myocardial hypoxia during high levels of performance as a soccer player.


Keywords: coronary aneurysm; left main coronary disease; intravascular ultrasonography; electron beam computed tomography     

Leaflet length and left main coronary artery occlusion following transcatheter aortic valve replacement

Coronary artery occlusion during transcatheter aortic valve replacement is a rare complication. However, it is a very severe and life‐threatening event. Although there are some possible causes of this phenomenon, definite etiologies and predictors are unknown because of the small number. We describe one case of left main coronary artery occlusion immediately after deployment of a prosthetic valve. The patient became hypotensive and developed cardiopulmonary arrest. However, the coronary artery was successfully stented with a help of cardiopulmonary bypass and he recovered well. In this case, pre‐procedural computed tomography (CT) showed the adequately high coronary height and no other significant conventional predictor for coronary occlusion. The examinations were retrospectively reviewed and the CT showed a long leaflet compared to the coronary sinus complex. The fluoroscopy appeared to show the long leaflet covering the left main coronary artery ostium immediately after the valve deployment. The height of the coronary artery ostium from the aortic annulus appeared sufficiently high in this case and did not explain the coronary compromise; leaflet length in relation to the coronary sinus dimension seemed more relevant. The ratio between leaflet length and curved coronary sinus height (L/C) may be one novel predictor for coronary artery occlusion. © 2013 Wiley Periodicals, Inc.     

Left main coronary artery atresia diagnosed by multidetector computed tomography

Left main coronary artery atresia is an extremely rare disease. Differential diagnosis of left main coronary artery atresia from atherosclerotic occlusion of left main coronary artery is difficult even if performing invasive coronary angiography. We present a case of a 48-year-old male with left main coronary artery atresia. Echocardiography showed left ventricular dysfunction. Invasive coronary angiography showed absence of left main coronary artery. A multidetector computed tomography showed a string-like structure at the site of left main coronary artery. A diagnosis of left main coronary artery atresia was made, and he underwent coronary artery bypass grafting. At the operation, a thin and not-sclerotic left main coronary artery was observed. Echocardiography, performed after the surgery, showed normalization of the left ventricular systolic function. Multidetector computed tomography might be a useful method to diagnose left main coronary artery atresia.     

Retrograde left main stenting

Percutaneous transluminal coronary angioplasty of protected left main coronary artery stenosis is usually performed by an antegrade approach. In this case report, we describe left main coronary artery stenting by a retrograde approach through a saphenous venous graft in a patient in whom the antegrade approach was considered less appropriate due to chronic ostial occlusion. © 1996 Wiley-Liss, Inc.     

Complete occlusion at the origin of the common trunk of the left coronary artery with intercoronary and aorto-coronary anastomotic circle: description of a case]

We describe the case of a patient with unstable angina and left main coronary artery occlusion, yet with good collateral circulation from the right coronary artery, and with normal left ventricular function. We identified an anomalous vessel from the ascending aorta ensuring a good supply to the left coronary artery.     

Emergency stenting of unprotected left main coronary artery after acute catheter-induced occlusive dissection

Left main coronary artery dissection occurs very rarely during selective coronary angiography, but it generally progresses to complete coronary occlusion. The traditional treatment of occlusive dissection of the unprotected left main coronary artery has been surgical. Percutaneous treatment has been sporadic and controversial. We report a case of iatrogenic occlusive dissection of the unprotected left main coronary artery during diagnostic coronary angiography, followed by successful stenting of the lesion.     

Successful use of sirolimus-eluting stents for treatment of ST-elevation acute myocardial infarction caused by left main coronary artery occlusion

We describe an ST-elevation acute myocardial infarction involving the left main coronary artery in a middle-aged man who was treated by primary angioplasty with the use of sirolimus-eluting stents. To our knowledge, this is the 1st report of survival after sirolimus-eluting stent implantation in a patient with acute occlusion of the left main coronary artery. We discuss the case and review the literature.     

Emergency stenting of totally occluded left main coronary artery in acute myocardial infarction

We report a case of emergency stenting for acute occlusion of the left main coronary artery in the setting of acute myocardial infarction. Although stent implantation allowed prompt revascularization and successful immediate management of this life-threatening condition, subacute stent thrombosis occurred, requiring re-PTCA followed by surgical revascularization. This case suggests that stenting of an acutely occluded left main coronary artery may be a life-saving procedure but should only be used as a bridge to surgery rather than a definitive treatment modality.     

Catheter-induced left main coronary artery dissection resulting in abrupt closure and cardiac arrest: successful stenting during resuscitation

Catheter-induced left main coronary artery dissection is an uncommon but devastating complication of coronary angiography and percutaneous coronary intervention. We present a case of left main coronary artery dissection induced with a guide catheter, which resulted in acute occlusion and cardiac arrest. Survival and complete functional recovery were achieved with bailout stenting.