Thrombolysis of acute total occlusion of the left main coronary artery and long-term survival.
A young woman was admitted with acute anterior myocardial infarction. Emergency coronary angiography showed a total occlusion of the LMCA. Selective infusion of streptokinase recanalized the left main coronary artery (LMCA), the circumflex artery, and the first diagonal, but not the entire left anterior descending artery (LAD). The right coronary artery was dominant and normal. The left-sided congestive heart failure was severe; treatment improved the heart failure and the patient was discharged on Day 25. She was readmitted for control 28 months later: she was only moderately disabled and coronary angiography showed the same occlusion of the LAD; result on ejection fraction (right anterior oblique view 30 degrees) was not significant, but circumflex artery recanalization probably preserved lateral wall contraction. The presence of a normal dominant right coronary artery seems to be a very important factor in contributing to initial survival.
D000328:Adult; D003327:Coronary Disease / Q000188:drug therapy*; D005260:Female; D006801:Humans; D011379:Prognosis; D013300:Streptokinase / Q000627:therapeutic use*
D013300:Streptokinase