Chronic total occlusion of the three major coronary arteries: Clinical and angiographic observation of five cases

Abstract

Total occlusion of the three major coronary arteries (left anterior descending, left circumflex, and right coronary artery) is a rare occurrence. Out of 5400 patients who have had coronary angiography, three men and two women (0.0009%), aged 43–76 years old, showed total occlusion of all the major coronary arteries. Each had a long history of myocardial ischemia and two showed unstable angina. Four had suffered previous myocardial infarction. The majority of the sites of occlusion were in the middle section. One patient having proximal occlusion died suddenly. In three patients with good collateral flow, the left ventricular function was well preserved; however, in two patients who lacked sufficient collateral flow, the left ventricular function was markedly impaired. Effective symptomatic relief can be obtained by bypass grafting. Two patients continued to have severe angina despite intensive medical treatment.