Urgent rotational ablation of a partially protected, totally occluded left main coronary artery

Coronary artery by-pass surgery (CABG) is considered the treatment of choice for patients with significant stenosis of the left main coronary artery. However, with reduction of the flow post-CABG, the left main may become totally occluded. This may become important once graft failure occurs. This case describes a patient who had by-pass surgery for critical left main stenosis and was re-admitted four months later with graft failure and total occlusion of his left main, necessitating urgent rotational ablation of this partially protected, totally occluded left main coronary artery. This case raises the question of 'prophylactic' left main angioplasty soon after surgery for critical left main stenosis, in order to eliminate the need for redo operation once graft failure occurs.