Nazim Megherbi, Brahim Arab, Redouane Nedjar, Wathik Takdemt, Said Benghezel, Mohamed Abed Bouraghda and Mohamed Chettibi
Frantz Fanon University, Algeria
Scientific Tracks Abstracts: J Clin Exp Cardiolog
Introduction Aim: Acute total occlusion of the Left Main (LM) is rarely encountered in the cathlab, its incidence is diffi cult to determine because most oft en fatal. Th is is a frightening situation where there is a paucity of data. We report 4 cases of total occlusion of the left main revealed by an acute coronary syndrome observed between the year 2015 and 2016 in our cathlab Case Report: Th e age of patients was between 29 and 72 years with tobacco as a common risk factor; three patients were admitted for NSTEMI at high risk and two for STEMI, one of whom was with failure of thrombolysis. Of the 5 patients 3 presented in shock. Th e delay for revascularization was between 1 hour and 5 hours for the fi rst four patients, this delay was 26 hours for the last one. Th e EKG of our patients was characterized by a labile aspect from one patient to another, the ST segment elevation in AVR was observed in all the patients. Only one patient had an LVEF altered at the echography. In the fi rst three patients, coronary angiography showed a completely occluded LM (TIMI 0, RENTROP 0), they underwent instrumental thrombectomy under anti-GPIIbIIIa treatment with restoration of a satisfactory coronary fl ow at a fi rst step, a delayed angiographic control of 48 hours showed a coronary arteries without signifi cant lesion in one patient while the two others underwent angioplasty. Th e fourth patient had a complete occlusion of the LM; a dominant RCA with a tight stenosis on its second segment overtaking the LAD (RENTROP II), an urgent surgical revascularization was performed for this patient. For these fi rst four patients the evolution was favorable. Th e fourth patient illustrates the severity of this lesion, the patient came late to our level aft er the failure of thrombolysis where coronary angiography revealed an occluded LM without collaterals (REnTROP 0), thrombo-aspiration associated with anti GpIIbIIIa therapy could restore a TIMI III fl ow but a bad LAD artery continued to degrade its cardiac insuffi ciency leading to the death at the 5th day of hospitalization. Conclusion: For this type of lesion angioplasty is a saving option; the prognosis is generally related to the right or left dominance, the development of collateral circulation and especially the celerity of revascularization. Delayed stenting seems to appear safe in order to reduce the risk of embolization and no refl ow. Surgical revascularization is a reasonable attitude when the patient is stable with a low operative risk.