Chronic Total Occlusion of Coronary Left Main Artery Supplied by Right Collaterals under Vascular Endothelial Growth Factor Inhibitor Therapy

We report a rare case of a patient who despite being under anti VEGF : Bevacizumab , developed a large coronary collateral circulation completely supplying the chronic total occlusion of left main coronary artery.

Bevacizumab, a monoclonal antibody was the first potent angiogenic inhibitor , targeting vascular endothelial growth factor (VEGF)-A.

Some of it's important cardiovascular adverse events include arterial and venous thrombotic events, coronary artery disease and heart failure resulting from inhibition of endothelial regeneration.

Our patient developed dyspnea after 1 year of receiving bevacizumab with a chronic total occlusion of the left main coronary artery with the particularity of developing extensive collaterals despite the anti VEGF treatment she received.