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- Title
Acute Occlusion of a "Protected" Left Main Coronary Artery Manifesting as an Acute Coronary Syndrome with Heart Failure: How much Protected it is?
- Authors
Jariwala, Pankaj; Kulkarni, Gururaj Pramod; Mishra, Krushna Chandra; Jariwala, Anusha
- Abstract
Despite the progress made in technological advancements, the utilization of stenting for both protected and unprotected left main coronary artery (LMCA) disease remains associated with elevated rates of long-term mortality and significant adverse clinical events, sometimes manifesting as cardiogenic shock. A considerable number of individuals retain the opportunity to receive catheter-based interventional therapy as a viable substitute for re-operative coronary artery bypass grafting (CABG). Despite the changed appearance, patients with acute blockage of the protected LMCA still have major adverse cardiac events (MACE) at a similar rate. Acute occlusion of the unprotected LMCA as an acute coronary syndrome (ACS) is uncommon, but that of the protected LMCA is relatively rare. We present a case of a post-CABG patient who developed ACS as a posterior wall myocardial infarction and acute left ventricular failure due to obstruction of a protected LMCA with substantial stenosis across its distal segment extending to the left circumflex (LCx) artery. The pharmaco-invasive management of the protected LMCA thrombotic occlusion with primary percutaneous coronary intervention resulted in significant patient improvement. These lesions are amenable to complex and high-risk coronary intervention with current technology, and the results have been quite encouraging in terms of long-term survival.
- Subjects
CORONARY arterial radiography; DIURETICS; STATINS (Cardiovascular agents); PATIENT aftercare; ENOXAPARIN; CORONARY artery bypass; PERCUTANEOUS coronary intervention; COMBINATION drug therapy; HOSPITAL emergency services; INTRAVENOUS therapy; BLOOD vessels; EMPAGLIFLOZIN; NITROGLYCERIN; SURGICAL complications; ACUTE coronary syndrome; MYOCARDIAL infarction; ACE inhibitors; NITRATES; ADRENERGIC beta blockers; CARVEDILOL; CORONARY angiography; CORONARY artery disease; ELECTROCARDIOGRAPHY; PLATELET aggregation inhibitors; LOW-molecular-weight heparin; CORONARY occlusion; CORONARY arteries; COMPUTED tomography; DISCHARGE planning; HEART failure; DISEASE risk factors
- Publication
Indian Journal of Clinical Cardiology, 2023, Vol 4, Issue 4, p295
- ISSN
2632-4636
- Publication type
Article
- DOI
10.1177/26324636231212023