A SURVIVAL STORY OF 47 YEARS OLD MALE WITH ACUTE TOTAL OCCLUSION OF LEFT MAIN AND COEXISTING OSTIAL RIGHT CORONARY ARTERY LESION

Abstract

Left main coronary artery (LMCA) thrombus occlusion causing acute coronary syndrome is an uncommon event and associated with severe life-threatening presentations. The clinical outcome depends on the age of the patients, presence of cardiogenic shock and the presence of dominant Right Coronary Artery (RCA) Early reperfusion is associated with improved outcomes.

A 47-years man presented with sudden substernal burning sensation and dry cough for 1 hour. Coronary angiography revealed an acute totally occlusion of ostial left main (LM) with TIMI flow grade 0 and dominant RCA with ostial 80% stenosis having TIMI flow grade 3 and Grade 1 contralateral collaterals from RCA to left system. Emergency percutaneous coronary intervention (PCI) was performed to ostial LMCA toward the proximal LAD to cover the whole LMCA and stage PCI was performed to ostial RCA. Patient was discharge on 7th day with good general condition. An electrocardiographic pattern is associated with collateral filling territories in unprotected left main (ULM) occlusion. In our case diagnosis was completely made after diagnostic coronary angiogram.

Acute total occlusion of LMCA is associated with arrhythmias, cardiogenic shock and sudden death. However, Patient was hemodynamically stable that showed indubitably the importance of dominant RCA with TIMI 3 flow and Grade 1 contralateral collaterals to left coronary circulation. We perform successful primary PCI of acute total occluded LMCA which shortened the ischemic time to salvage the ischemic myocardium.