Left mainstem coronary artery XXXX --death after angiography. A report of 5 cases.

@entity1 @entity583 @entity4785 @entity3361 @entity951 @entity432 @entity453 @entity850 @entity551 @entity1002
Death directly related to selective coronary arteriography in 5 @entity1 with a history of unstable @entity951 during the period 1975-1985 is reported. Four different cardiologists were involved. A feature common to all the cases was the presence of significant @entity850 of the left mainstem coronary artery (LMCA); 2 @entity1 had haemodynamically important obstruction of a dominant right coronary artery (RCA) ostium, while 2 others had @entity432 in the proximal part of a dominant RCA. The RCA in the last case was angiographically normal and non-dominant. Collateral coronary blood flow was fairly sparse in most cases and in 4 @entity1002 of varying degree was present. All @entity1 developed severe @entity551 and @entity4785 after arteriography while still in the cardiac catheterization laboratory. Resuscitation efforts were uniformly unsuccessful. Autopsy on 1 @entity1 demonstrated extensive obstructive @entity453 with a massive @entity583 . Cardiac catheterization poses an extremely high risk for this subgroup of @entity1 with @entity453 , as does selective coronary arteriography. The possible role of catheter-provoked @entity3361 is suggested; a recently introduced soft-tipped cardiovascular catheter may be more appropriate in this setting.
