Emergency stenting of totally occluded left main coronary artery in patients with unstable coronary artery disease

Acute occlusion of left main coronary artery (LMCA) is a rare angiographic finding, with a poor prognosis. Percutaneous transluminal coronary angioplasty (PTCA) with stenting in this situation is the fastest modality to restore and maintain coronary blood flow helping in successful immediate management. We report a case of emergent PTCA with stenting of unprotected LMCA in a patient with unstable coronary artery disease (UCAD) and cardiogenic shock. Angiography revealed a large dominant right coronary artery (RCA) with extensive collaterals. A dominant RCA seems to be a must to survive this condition with collaterals the main determinant of prognosis. This case suggests that angioplasty with stent placement can be used as a life saving procedure, primarily as a bridge to definite surgical revascularization.