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Coronary Leriche Syndrome: An Often Missed Sub-set Of Left Main STEMI – Renal.PlatoHealth.ai

Coronary Leriche syndrome: An often missed sub-set of left main STEMI

Leriche syndrome (1948, Annals of Surgery, College de Paris, France) is a famous eponym in Aortic vascular emergency, where a saddle-shaped thrombus folds across the Aortic bi-furcation resulting in bilateral lower limb vascular insufficiency.

Though such vascular emergencies can occur in any bifurcation point in a vascular tree, it is not often thought about in acute coronary syndrome.

Large thrombus burden in LAD or LCX is so commonly visualized, while in a stump left main, we often fail to recognize the fact, that it is almost the same as “saddle embolus” sitting across both LAD & LCX bifurcation.

Most such patients do not reach the hospital. If the thrombus migrates to one of the branches, it might evolve either as LAD STEMI, LCX STEMI, or a combination of both. We have seen a few lucky Left main STEMIs in the cath lab, with some spontaneous canalization.

Final message

De-novo Coronary Leriche syndrome is a real entity. For many of us this may appear, just an acute coronary curiosity, since most of the time it results in silent sudden deaths and escapes from our vision. However, primary PCI Interventionalists need to be aware of this concept, as meddling in this critical arena with high thrombus load can rapidly evolve into an acquired Leriche syndrome, for which the operator becomes squarely responsible.

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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