Total occlusion of left coronary artery. Incidence and management.

From July 1, 1972, to Jan. 1, 1978, 527 patients underwent coronary revascularization. In four (0.76%) of these patients arteriography demonstrated total occlusion of the left main coronary artery. The incidence of acquired occlusion of the left coronary artery encountered in the cardiac catheterization laboratory during the same period was 0.17% in patients undergoing coronary arteriography. Literature review reveals 13 patients with total occlusion of the left coronary artery, and only seven of these were treated operatively, some with suboptimal results. With an average of three grafts per patient, all four of our patients are in Class I of the New York Association an average of 23 months postoperatively. These patients were dramatically symptomatic preoperatively, and their clinical management in terms of pharmacologic or mechanical intraoperative support was no different from that of patients with critical stenosis of the left main coronary artery. This report documents the incidence of left coronary artery occlusion encountered in clinical practice. This incidence should not be as rare as the literature review suggests.