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Total occlusion of left coronary artery. Incidence and management
Insights
Total occlusion of the left main coronary artery is more common than previously thought. Early surgical intervention with coronary artery bypass grafting yields excellent outcomes for these patients.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Left main coronary artery occlusion is a rare but critical condition.
- Previous literature suggests a low incidence and variable surgical outcomes.
Purpose of the Study:
- To determine the incidence of left main coronary artery occlusion in patients undergoing revascularization.
- To report on the surgical outcomes of patients with this condition.
Main Methods:
- Retrospective review of 527 patients undergoing coronary revascularization from 1972-1978.
- Analysis of arteriography findings and patient outcomes.
Main Results:
- Four patients (0.76%) presented with total left main coronary artery occlusion.
- All four patients received an average of three bypass grafts and achieved excellent functional recovery (New York Heart Association Class I) at 23 months.
- The incidence in cardiac catheterization patients was 0.17%.
Conclusions:
- Left main coronary artery occlusion is likely underreported in existing literature.
- Surgical revascularization offers a highly effective treatment option with favorable long-term outcomes.
Abstract:
From July 1, 1972, to Jan. 1, 1978, 527 patients underwent coronary revascularization. In four (0.76%) of these patients arteriography demonstrated total occlusion of the left main coronary artery. The incidence of acquired occlusion of the left coronary artery encountered in the cardiac catheterization laboratory during the same period was 0.17% in patients undergoing coronary arteriography. Literature review reveals 13 patients with total occlusion of the left coronary artery, and only seven of these were treated operatively, some with suboptimal results. With an average of three grafts per patient, all four of our patients are in Class I of the New York Association an average of 23 months postoperatively. These patients were dramatically symptomatic preoperatively, and their clinical management in terms of pharmacologic or mechanical intraoperative support was no different from that of patients with critical stenosis of the left main coronary artery. This report documents the incidence of left coronary artery occlusion encountered in clinical practice. This incidence should not be as rare as the literature review suggests.