The authors describe a fifty-five-year-old Japanese man with an acute extensive anterior myocardial infarction associated with a total occlusion of the left main coronary artery. The patient suffered cardiogenic shock and was treated successfully with rescue percu taneous transluminal coronary angioplasty and an intraaortic balloon pump (IABP) after unsuccessful intracoronary thrombolysis. Ten days after admission, he was weaned from IABP, and recovery-phase coronary angiography revealed no significant coronary artery stenosis and an ejection fraction of 32% by left ventriculography. The patient was discharged from the hospital without any ischemic findings.
Get full access to this article
View all access options for this article.
References
1.
Kajiyama M., Yoshida O., Oka Y., et al: Clinical features of acute myocardial infarction due to left main trunk occlusion. Coronary6:337-341, 1989 (in Japanese).
2.
De Feyter PJ , Serruys PW: Thrombolysis of acute total occlusion of the left main coronary artery in evolving myocardial infarction. Am J Cardiol53: 1727-1728, 1984.
3.
Rentrop KP, Blanke H., Karsch KR, et al: Initial experience with transluminal recanalization of the recently occluded infarct-related coronary artery in acute myocardial infarction: Comparison with conventionally treated patients. Clin Cardiol2:92-105, 1979.
4.
Grunzig AR: Transluminal dilatation of coronary artery stenosis. Lancet1:263, 1978.
5.
Herrick J.: Clinical features of sudden obstruction of the coronary arteries. JAMA59:2015-2020, 1912.
6.
Flugelman MY , Shalit M., Shefer A., et al: Survival after sudden obstruction of the left main coronary artery. Am J Cardiol51:900-901, 1983.
7.
Cohen MC, Ferguson DW: Survival after myocardial infarction caused by acute left main coronary artery occlusion: Case report and review of the literature. Cathet Cardiovasc Diagn16:230-238, 1989.
8.
Goldberg S., Brossman W., Markis JE, et al: Total occlusion of the left main coronary artery. Clinical, hemodynamic and angiographic profile. Am J Med64:3-8, 1978.
9.
Trnka KE, Febres-Roman PR, Cadigan RA, et al: Total occlusion of the left main coronary artery: Clinical and catheterization findings. Clin Cardiol3:352-355, 1980.
10.
Cribier A., Berland J., Brunhes G., et al: Acute coronary occlusion during coronary angiography in two cases. Treatment by transluminal disobliteration. Br Heart J47:244-248, 1982.
11.
Salvi A., Klugelmann S., Grazia ED, et al: Myocardial reperfusion after acute occlusion of the left main coronary artery. Am J Cardiol51:1791, 1983.
12.
vonEssen R. , Lamberts H., Schmidt W., et al: Successful recanalization of a left main coronary artery occlusion. Am J Cardiol53:356-357, 1984.
13.
Erbel R., Meinerts T., Wessler I., et al: Recanalization of occluded left main coronary artery in unstable angina pectoris. Am J Cardiol53:1725-1727, 1984.
14.
Weyne AE, Colardyn FA, Heyndrickz GR, et al: Survival after acute myocardial infarction associated with total obstruction of left main coronary artery. Am J Cardiol55:1423-1424, 1985.
15.
Cox WR: Left main coronary thrombolysis. Cathet Cardiovasc Diagn11:269-271, 1985.
16.
Alosillia CE , Bell WW, Ferree J., et al: Thrombolytic therapy during acute myocardial infarction due to sudden occlusion of the left main coronary artery . J Am Coll Cardiol5:1253-1256, 1985 .
17.
Hara H., Kosuga K., Aoyagi S., et al: Coronary bypass surgery after thrombolytic therapy for total occlusion of the left main coronary artery. Kurume Med J33: 113-116, 1986.
18.
Sigwart U., Goy JJ, Finci L., et al: Mechanical emergency recanalization of the left main coronary artery. Clin Cardiol9:217-222, 1986.
19.
Siemons L., Ranquin R., van den Heuvel P., et al: Intravenous streptokinase-mediated thrombolysis of acute occlusion of the left main coronary artery. Am J Cardiol60:1403-1404, 1987.
20.
O'Shaughnessy MA, Ransbottom JC, Stiles BS, et al: Acute left main coronary artery occlusion. Survival following emergent coronary bypass. Arch Intern Med147:2207-2208, 1987 .
21.
Waters DD, Boucher B., Chabot M., et al: Uncomplicated non-Q wave infarction caused by total obstruction of the left main coronary artery. Am Heart J113:1224-1226, 1987.
22.
Finzi Lap, Secches AL, Evora Prb, et al: Myocardial reperfusion by thrombolysis after acute total left main artery occlusion—a case report. Angiology38:417-421, 1987.
23.
Biron Y., Laurent M., Bourdonned C., et al: Thrombolysis of acute total occlusion of the left main coronary artery and long-term survival. Clin Cardiol10:283-285, 1987.
24.
Takayanagi K., Satoh T., Inoue T., et al: Survival from acute occlusion of the left main coronary artery pre-existing collateral vessels—a case report . Angiology42:935-939, 1991.
25.
Nyui S., Inoue S., Sato T., et al: Acute left main coronary artery occlusion—a case report and review of the literature. Jpn Circ J55:281-286, 1991.
26.
Matsumoto M. , Konishi Y., Nishizawa J., et al: Total occlusion of the left main coronary artery associated with acute myocardial infarction . A case report. Jpn Circ J56:128-132, 1992.
27.
Lijoi A., Revere FD, Passerone GC, et al: Emergency surgical treatment for total left main coronary artery occlusion. A report of two cases. Texas Heart Inst J20:55-59, 1993.
28.
Lew AS, Weiss AT, Shan PK, et al: Extensive myocardial salvage and reversal of cardiogenic shock after reperfusion of the left main coronary artery by intravenous streptokinase . Am J Cardiol54:450-452, 1984.
29.
Gissi: Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction . Lancet 1:397-401, 1986.
30.
Lee L., Bates ER, Pitt B., et al: Percutaneous transluminal coronary angioplasty improves survival in acute myocardial infarction complicated by cardiogenic shock. Circulation78:1345-1351, 1988.
31.
Lee L., Erbel R., Brown TM, et al: Multicenter registry of angioplasty therapy of cardiogenic shock: Initial and long-term survival. J Am Coll Cardiol17:599-603, 1991.
32.
Gacioch GM, Ellis SG, Lee L., et al: Cardiogenic shock complicating acute myocardial infarction: The use of coronary angioplasty and the integration of the new support devices into patient management. J Am Coll Cardiol19:647-653, 1992.
33.
Stack RS, O'Corner CM, Mark DB, et al: Coronary perfusion during acute myocardial infarction with a combined therapy of coronary angioplasty and high-dose intravenous streptokinase . Circulation77:151-161, 1988.
