This case report describes the use of intracoronary thrombolysis followed by emergency CABG for total left main coronary artery occlusion, which resulted in initial recanalization but ultimate mortality due to complications.
Extreme caution warranted with thrombolysis plus emergency CABG in left main occlusion; leaves open optimal strategy for total occlusion.
A 73-year-old man with a history of ischemic heart disease was diagnosed with an extensive, acute anterior myocardial infarction. Coronary arteriography demonstrated total occlusion of the left main coronary artery, and the right coronary artery was predominant. Selective intracoronary thrombolysis was initiated immediately with a total dose of 480, 000 IU of urokinase and resulted in recanalization to a 99% diameter stenosis of the LMCA. Emergency coronary artery bypass grafting was performed 7 hours after recanalization. An intra-aortic balloon pump, inserted before the operation, was removed on the 8th day after the operation. The post operative course seemed to be good; but the patient expired from acute renal failure and sepsis, 45 days after the operation.
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Hara et al. (1986) studied this question.
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