We report the case of a patient with isolated occlusion of the left main and normal left ventricular function. The presenting symptom was effort angina. Three major coronary risk factors were present: family history of CAD, cigarette smoking and type IIB hyperlipoproteinemia. Coronary angiography showed a right dominance and an effective collateral circulation to the left anterior descending and circumflex arteries. Surgical revascularization was considered the first choice treatment. We reviewed the most important literature on this topic and we concentrated especially on collateral circulation. We maintain it plays a role not only in preserving left ventricular function but also in precipitating left main occlusion by means of a flow competition mechanism.
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