Total occlusion of the left main coronary artery: clinical and catheterization findings.

In this report clinical and angiographic data on three patients with total occlusion of the left main coronary artery is presented. Two of our cases demonstrated rich collateralization with good preservation of left ventricular (LV) function. The third case, with initial subtotal occlusion and no collaterals, sustained a severe anterolateral myocardial infarction (MI) responding to the use of the intra-aortic balloon pump (IABP). This report is consistent with the findings of others who suggest the possible beneficial effect of collaterals in preserving myocardial contractility in this unusual situation. We suggest that the IABP may be of benefit in patients with total occlusion of the left main coronary artery and sparse collaterals who remain unstable and cannot be operated on immediately.