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Case Reports
. 2007;34(4):479-84.

Unprotected left main coronary artery intervention for acute myocardial infarction and cardiogenic shock

Mohammed M Abuzahra  1 , Andres Mesa, Bernardo Treistman
Affiliations
Case Reports

Unprotected left main coronary artery intervention for acute myocardial infarction and cardiogenic shock

Mohammed M Abuzahra et al. Tex Heart Inst J. 2007.

Abstract

Medical therapy alone often insufficiently alters the clinical course of patients who have experienced acute myocardial infarction and concomitant cardiogenic shock, and in whom the left main coronary artery is the culprit vessel. Emergency coronary artery bypass grafting is an effective yet time-consuming approach that entails the risk of extensive, irreversible myocardial damage. Percutaneous coronary intervention in the unprotected left main coronary artery can enable initial revascularization and rapid stabilization even in high-risk patients, but outcomes from the procedure since the recent advent of drug-eluting stents are still being determined. Herein, we report the successful deployment of a sirolimus-eluting stent in a 65-year-old man who had experienced acute myocardial infarction and cardiogenic shock consequent to an occluded left main coronary artery. The patient recovered rapidly and completely. We review the medical literature and compare percutaneous coronary intervention with other methods of treatment.

Keywords: Angioplasty, transluminal, percutaneous coronary; coronary angiography; coronary disease/complications/mortality/radiography; coronary restenosis/prevention & control; drug implants; myocardial infarction/complications/therapy; myocardial revascularization/methods; prognosis; shock, cardiogenic/diagnosis/etiology/therapy/ultrasonography; stents; treatment outcome.

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Figures

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Fig. 1 Before intervention: Coronary angiography (20° right anterior oblique view) shows the left main coronary lesion (arrow).
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Fig. 2 After intervention: Coronary angiography (20° right anterior oblique view) shows the left main coronary artery.
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Fig. 3 Before intervention: Coronary angiography (left anterior oblique caudal view) shows the left circumflex coronary ostial lesion (arrow).
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Fig. 4 After intervention: Coronary angiography (left anterior oblique caudal view) shows the ostium of the left circumflex coronary artery.
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Fig. 5 After intervention: Intravascular ultrasonography of the left main coronary artery. The external elastic membrane and luminal cross-sectional area is 11 mm2.
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Fig. 6 After intervention: Intravascular ultrasonography of the proximal segment of the left anterior descending coronary artery. The external elastic membrane area is 11.6 mm2; the luminal cross-sectional area is 7.7 mm2.
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Fig. 7 Before intervention: Intravascular ultrasonography of the left circumflex ostial lesion. The luminal cross-sectional area is 3.8 mm2. The left main–left anterior descending coronary artery stent is partially visible (arrows).
See this image and copyright information in PMC

References

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