Coronary Leriche syndrome: An usually missed sub-set of left essential STEMI

Leriche syndrome (1948, Annals of Surgical procedure, Faculty de Paris, France) is a well-known eponym in Aortic vascular emergency, the place a saddle-shaped thrombus folds throughout the Aortic bi-furcation leading to bilateral decrease limb vascular insufficiency.

Although such vascular emergencies can happen in any bifurcation level in a vascular tree, it isn’t usually considered in acute coronary syndrome.

Giant thrombus burden in LAD or LCX is so generally visualized, whereas in a stump left essential, we frequently fail to acknowledge the actual fact, that it’s virtually the identical as “saddle embolus” sitting throughout each LAD & LCX bifurcation.

Most such sufferers don’t attain the hospital. If the thrombus migrates to one of many branches, it’d evolve both as LAD STEMI, LCX STEMI, or a mixture of each. Now we have seen a couple of fortunate Left essential STEMIs within the cath lab, with some spontaneous canalization.

Ultimate message

De-novo Coronary Leriche syndrome is an actual entity. For many people this may increasingly seem, simply an acute coronary curiosity, since more often than not it leads to silent sudden deaths and escapes from our imaginative and prescient. Nonetheless, major PCI Interventionalists want to concentrate on this idea, as meddling on this important enviornment with excessive thrombus load can quickly evolve into an acquired Leriche syndrome, for which the operator turns into squarely accountable.

Reference

1.Leriche R, Morel A. The Syndrome of Thrombotic Obliteration of the Aortic Bifurcation. Ann Surg. 1948 Feb;127(2):193-206. doi: 10.1097/00000658-194802000-00001. PMID: 17859070; PMCID: PMC1513778.

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