A Practical and Effective Protocol for the Post Angiographic Management of Patients with Critical Stenosis of the Left Main Coronary Artery

Abstract

The management of newly diagnosed left main obstruction varies through out institutions. At some Centers, very aggressive measures including intra- aortic balloon counterpulsation and emergent revascularization are routine protocol. Twenty consecutive patients with greater than 50% luminal narrowing of the left main coronary artery were treated over a 1 year period. Routine post catheterization protocol for 19 patients included intensive care observation, continuation of nonparenteral anti-anginal agents, and coronary revasculariza tion within 24 hours of diagnosis. One patient experienced severe hemodynamic embarrassment at the time of catheterization and underwent emergency coro nary bypass. All patients were discharged uneventfully following successful sur gery. Based on this experience, it is felt that with surgical support, patients with significant left main stenosis can be treated with standard anti-anginal therapy, and undergo elective revascularization without complications.