Ostial left main coronary artery chronic total occlusion presenting as chronic stable angina
K Kanabar1, S Mehrotra1, Rajan P1
1Department of Cardiology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.
Insights
This case study highlights a rare instance of chronic total occlusion of the left main coronary artery (LMCA) in a young woman presenting with stable angina. The successful surgical intervention underscores treatment possibilities for this unusual coronary artery disease presentation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Significant left main coronary artery (LMCA) disease affects 5-6% of patients undergoing coronary angiography, often presenting as acute coronary syndrome.
- Complete occlusion of the LMCA is rare, typically associated with severe symptoms like myocardial infarction or cardiogenic shock.
Observation:
- A young female presented with chronic stable angina and an isolated chronic total occlusion (CTO) of the LMCA.
- The aortogram revealed collateral filling of the left coronary system via the right coronary artery, with no stump of the occluded LMCA visible.
- The patient had dyslipidemia but no other traditional risk factors for coronary artery disease (CAD).
Findings:
- Extensive evaluation ruled out non-atherosclerotic causes like vasculitis for the LMCA CTO.
- The patient successfully underwent coronary artery bypass grafting for the isolated LMCA CTO without complications.
Implications:
- This case demonstrates that isolated LMCA CTO can occur in young individuals without typical CAD risk factors.
- It highlights the importance of considering non-atherosclerotic etiologies and the feasibility of surgical revascularization in rare LMCA CTO cases.
- Successful management of this rare condition expands understanding of coronary artery disease presentations and treatment options.
Abstract:
Significant left main coronary artery (LMCA) disease is found in 5-6% of all patients undergoing coronary angiography. It usually presents as acute coronary syndrome and is commonly associated with multi-vessel coronary artery disease (CAD). Complete occlusion of LMCA is a much rarer finding, since these patients usually present as unstable angina, myocardial infarction and cardiogenic shock. We report a case of a young female, who presented with chronic stable angina and had an isolated chronic total occlusion (CTO) of LMCA with no lesions in the other coronary arteries. Aortogram failed to demonstrate the stump of occluded LMCA and demonstrated the filling of the left coronary system from the right coronary artery. Apart from dyslipidemia, she had no other risk factors for CAD. She was extensively evaluated for non-atherosclerotic causes of LMCA CTO including vasculitis. She underwent coronary artery bypass graft successfully without any peri-procedural complications.
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