Coronary Bypass Surgery after Thrombolytic Therapy for Total Occlusion of the Left Main Coronary Artery

A 73-year-old man with a history of ischemic heart disease was diagnosed with an extensive, acute anterior myocardial infarction. Coronary arteriography demonstrated total occlusion of the left main coronary artery, and the right coronary artery was predominant. Selective intracoronary thrombolysis was initiated immediately with a total dose of 480, 000 IU of urokinase and resulted in recanalization to a 99% diameter stenosis of the LMCA. Emergency coronary artery bypass grafting was performed 7 hours after recanalization. An intra-aortic balloon pump, inserted before the operation, was removed on the 8th day after the operation. The post operative course seemed to be good; but the patient expired from acute renal failure and sepsis, 45 days after the operation.