Direct angioplasty of totally occluded left main coronary artery in acute myocardial infarction complicated by cardiogenic shock: report of two cases and literature review.

: Acute total occlusion of the left main coronary artery is usually characterized by a rapid course of deterioration that challenges therapeutic intervention. Unlike subtotal occlusion of the left main coronary artery, acute total occlusion of the left main coronary artery is extremely rare and has a grave prognosis. Most patients with this problem die suddenly or go into cardiogenic shock. Direct percutaneous transluminal coronary angioplasty (PTCA) was performed on 2 patients, both suffering from cardiogenic shock due to acute total occlusion of the left main coronary artery. Both patients underwent coronary artery bypass surgery subsequently. One patient, who had substantial intercoronary collaterals, remained asymptomatic at 31 months of follow-up. The other, who had no intercoronary collateral circulation, expired 3 days after coronary artery bypass surgery. We conclude that direct PTCA to the acutely occluded unprotected left main coronary artery in cardiogenic shock patients is a potentially life-saving procedure, and the presence or absence of collaterals from the dominant right coronary artery will influence the clinical outcome.