Angina Equivalent and Revascularization in a Diabetic Patient with a Chronic Total Occlusion of a Single Coronary Artery

Abstract

Submit Manuscript | http://medcraveonline.com The initial test performed was an echocardiogram that showed a non dilated left ventricle with mild concentric hypertrophy, preserved LVEF (left ventricle ejection fraction) with normal wall motion, diastolic dysfunction (alteration of the ventricular relaxation). Valvular morphology and function were normal. We then decided to perform a SPECT stress test on a cyclo-ergometer, that showed development of significant hipoperfusion in all inferior wall segments with extension to posterior wall (Figure 2) with partial recovery with rest (Figure 3). During the test, the patient developed progressive dyspnea and vegetative symptoms that disappeared with rest. Following these results, a coronary catheterization was indicated. Left main coronary artery had no significant lesions, circumflex artery had a non severe lesion in the second marginal branch and the right coronary artery was chronically occluded in the proximal segment, with the presence of collateral circulation (Rentrop 3). SYNTAX Score was 12 points. After beginning medical treatment with atorvastatin, carvedilol and acetylsalicylic acid the patient presented only a slight improvement, so we decide to add clopidogrel and perform a percutaneous revascularization of the total chronic occlusion. Angioplasty was successfully performed (Figures 4-7), with the implantation of two everolimus DES (drug-eluting stents). The patient had a good clinical evolution with total disappearance of the symptomatology.