Critical left main coronary artery stenosis diagnosed by computed tomography coronary angiography

Jeffrey M. Schussler, MD, William D. Dockery, MD, Kenneth B. Johnson, MD, Robert L. Rosenthal, MD, and Robert C. Stoler, MD

A 60-year-old man with previous cerebrovascular accident, hypercholesterolemia, and tobacco use presented with a several-month history of worsening exertional dyspnea. Immediate catheterization was considered unsafe, as the patient was taking warfarin (international normalized ratio, 2.9), and nonemergent, as the patient's symptoms were relatively stable. Warfarin was stopped, and multislice computed tomographic coronary angiography (CTCA) was performed (Lightspeed 16, GE Systems) after obtaining appropriate consent. CTCA demonstrated a high-grade narrowing at the ostium of the left main coronary artery. The ostium of the left main coronary artery had a tapered appearance and a large plaque in its ostial and proximal portions. A large amount of plaque was seen in all coronary distributions.