Left Main Total Chronic Occlusion in a Patient with Colorectal Cancer: A Case Report of a Rare and Severe Localization of Coronary Artery Disease

The aim of this case report is to draw attention at the potential severity of presentation of these associated pathologies. Prevention through early screening of colorectal cancer in patients with coronary artery disease and vice versa is the guarantee of a better management of the two pathologies. Cardiovascular disease and cancer are the two leading causes of death worldwide. Emerging evidence suggests associations between cardiovascular disease and several cancers, including colorectal cancer. Many cases have reported severe coronary artery disease (CAD) in association with colorectal cancer including triple vessel disease. To the best of our knowledge this is the first case reporting a total occlusion of the left main coronary artery in such patients.

We report the case of a 52 years old woman presented to our cath lab for severe angina (Class III of the Canadian classification) and impairment of left ventricle function. Six months before the patient was diagnosed with a metastatic colorectal cancer. Coronary angiography showed absence of anterograde opacification of the left coronary system. Selective right coronary artery angiography showed a retrograde filling of the left coronary system by collaterals issued from proximal and distal dominant right coronary artery.

Several studies have reported the association between colorectal neoplasm and CAD but Isolated left main coronary artery disease is extremely uncommon. Patients with left main coronary artery disease have always a grim prognosis and without prompt revascularization 60% will die after 5 years while survivors live with severe angina; heart failure or both.