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. 2009 Aug;17(7-8):274-6.
doi: 10.1007/BF03086264.

Primary percutaneous coronary intervention in the left main stem of a monocoronary artery

M Basalus  1 , J W Louwerenburg, K G van Houwelingen, M G Stoel, C von Birgelen
Affiliations

Primary percutaneous coronary intervention in the left main stem of a monocoronary artery

M Basalus et al. Neth Heart J. 2009 Aug.

Abstract

In a 71-year-old female with evolving anterior wall myocardial infarction, coronary angiography revealed a monocoronary artery which arose from the right sinus of Valsalva. Originating from a short common trunk, the left main stem showed a thrombotic lesion that occluded the left anterior descending coronary artery while the circumflex artery was obstructed. Intracoronary administration of abciximab, followed by stenting of the transition between the left anterior descending coronary artery and the main stem, and final kissing balloon inflation of the bifurcation resulted in an excellent angiographic result and favourable clinical outcome. (Neth Heart J 2009;17:274-6.).

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Figures

Figure 1
Figure 1
Coronary angiography and aortography. Angiography of the right coronary artery (RCA) revealed no stenosis but wall irregularities in the right descending posterior (RDP) artery (A, B). Aortography (C) showed the common coronary trunk of a monocoronary artery (marked by star), arising from the right coronary cusp and dividing into the RCA and left main stem (LM). Retrospectively, the left main stem was hazily visible during angiography of the RCA (A, arrowheads). Just proximal to the bifurcation of the LM into left anterior descending (LAD) and left circumflex (LCX) coronary arteries, a thrombus (D, arrowhead) occluded the LAD while the LCX was obstructed. Slow TIMI 2 flow was restored in the LAD after passing the lesion with a guidewire (E).
Figure 2
Figure 2
Percutaneous intervention in left main stem of monocoronary artery. The thrombus was resolved after intracoronary injection of a bolus of abciximab with a remaining stenosis of the left main bifurcation (A). Stenting of the left anterior descending artery (B, insert) resulted in a good result in the left main stem and anterior descending artery but worsened the proximal left circumflex artery (B). Final kissing balloon inflation (C, insert) resulted in an excellent angiographic result (C, D).
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