Surgery for Chronic Total Occlusion of the Left Main Stem: A 10-Year Experience

Akhtar, Raja Parvez; Naqshband, Mumraiz Salik; Abid, Abdul Rehman; Tufail, Zafar; Waheed, Abdul; Khan, Jawad

doi:10.1177/0218492309343857

Cited by 8 publications

(10 citation statements)

References 21 publications

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“…This type of chronic occlusion in the LMT is rare, occurring in only 0.025–0.4% of ischemic heart disease patients [ 2 ]. In our hospital, from April 2014 to March 2015, coronary angiography was performed 3 841 times at our hospital for patients suspected of having ischemic heart disease.…”

Section: Discussionmentioning

confidence: 99%

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A case of chronic left main trunk occlusion treated with off-pump coronary artery bypass grafting

Kawatani¹,

Nakamura²,

Hori³

2018

Journal of Surgical Case Reports

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Ischemic heart disease presents with various symptoms, and chest pain is a chief complaint. Occlusion of the left main trunk often results in serious symptoms such as cardiogenic shock. However, while extremely rare, left main trunk occlusion can present with only slight chronic symptoms. In the present case, a 62-year-old woman with few risk factors for ischemic heart disease visited our hospital complaining of exertional chest pain, which had gradually intensified over the past several years. Coronary artery computed tomography revealed total occlusion of the left main trunk, which was examined closely using coronary angiography. Coronary angiography showed that the left coronary artery was perfused by collateral pathways from the right coronary artery. The patient was thus diagnosed with chronic occlusion of the left main trunk. She underwent off-pump coronary artery bypass grafting, which proved to be an effective treatment.

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Section: Discussionmentioning

confidence: 99%

“…In contrast, chronic total occlusion (CTO) has an asymptomatic period, and when diagnosed its symptoms are often slight. CTO of the LMT is an extremely rare pathology, observed in only 0.025–0.4% of patients who undergo coronary angiography [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

A case of chronic left main trunk occlusion treated with off-pump coronary artery bypass grafting

Kawatani¹,

Nakamura²,

Hori³

2018

Journal of Surgical Case Reports

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“…It has been estimated that coronary chronic total occlusion (CTO) is encountered in 15 to 20% of patients referred for coronary angiography (CAG). Chronic total occlusion of left main coronary artery (LMCA) is rare on the angiograms and is described as a total lack of antegrade blood flow to the coronary arteries with retrograde collateral circulation [1,11]. Under these conditions, most of the myocardium is under ischemic stress, which is associated with high mortality.…”

Section: Cardiovascularmentioning

confidence: 99%

Percutaneous Intervention of Left Main Coronary Artery Chronic Total Occlusion

Kantaria

Agladze

Machavariani

et al. 2019

JCCI

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Chronic total occlusion (CTO) of the left main coronary artery (LMCA) is rare on the angiograms; Coronary Artery Bypass Grafting is the standard method of its revascularization. To demonstrate that PCI may in some cases be a safe option for patients with a high-risk surgical category, we report a complex clinical case of revascularization of chronic total occlusion of the LMCA, left anterior descending artery (LAD), and circumflex artery (CX). Methods Recanalization of the occluded LMCA and LAD was performed by utilizing the support-balloon technique, and CTO wires (Miracle 3™ wire, Abbott Vascular; Runthrough® NS Intermediate wire, Terumo); LAD, CX, LMCA, and its bifurcation, were stented with 3 drug-eluting stents (Resolute Integrity DES, Medtronic); the "Culotte Stenting " technique was used for bifurcation stenting, followed by "Kissing Balloon" post-dilatation technique; proximal optimization technique was performed in the LMCA. Results The intervention ended without complications. 2 months after stenting, the ejection fraction increased from 20% to 38%, improved almost all parameters of the heart, Congestive Heart Failure functional class decreased to class I. Conclusions It should be considered that LMCA CTO lesions can be successfully revascularized with PCI in case of the selection of the suitable patient and appropriate revascularization technique.

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“…[47][48][49] Successful revascularization rates are reported at 80% to 90% for CTOs of the left circumflex artery, with >80% of patients having all multiple CTOs treated successfully and concomitantly. 23,36 Fefer et al 36 showed that the presence of CTOs was not associated with increased mortality by multivariate analysis.…”

Section: Efficacy Of Cabg For Ctos Affecting Coronary Vessels Other Tmentioning

confidence: 99%