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Successful Percutaneus Revascularization of Total Occlusion of the Ostial Left Main Coronary Artery: A Rare Case Report

Author : D. Wardana, N.A. Tafriend, U. Bahrudin, Y. Herry
Upload Date : 19-04-2018

Background: Total occlusion of the ostial left main coronary artery (LMCA) is rare, and percutaneous coronary intervention (PCI) represent the most technically challenging procedure in interventional cardiology.

Case presentation: A-49-years-old, Asian, hypertensive, ex-cigarette smoking man with history of myocardial infarction presented with chest discomfort during daily activity. Physical examination was within normal limits. Electrocardiogram showed a pathological Q wave in V1–V3 and a slight ST depression in I, aVL and V6. Echocardiography demonstrated a regional wall motion abnormality with LVEF 43% by Teichz and 42% by biplane. Cardiac catheterization revealed a total occlusion of the ostium of LMCA without any antegrade flow in the left anterior descending (LAD) nor in the left circumflex artery (LCA). The right coronary artery supplied retrograde filling of the LAD artery via extensive septal collaterals. PCI with an antegrade approach was performed successfully. A drug eluting stent (DES) was implanted on the LMCA–LCA and another DES on the LMCA–LAD. He has remained asymptomatic over a six month follow up period.

Conclusion: We describe a rare total occlusion of the left main coronary artery which was successfully revascularized by percutaneous intervention. It is important to keep in mind that percutaneous coronary intervention is a visible approach for the selected patient with a total occlusion of the ostial left main coronary artery.

KEYWORDS : Total occlusion, left main coronary artery, percutaneous coronary intervention

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