Chronic total occlusions: Successful recanalization of very old lesions

Abstract

The treatment of chronic total occlusion is thought to be the final frontier in treating coronary artery disease nonsurgically. In the past, an old occlusion was not likely to be treated successfully percutaneous. We have had success in revascularizing some very old 20 plus year old occlusions percutaneously. Six patients were treated who had >20-year-old occlusions. Five patients were male; mean age of patients was 72.2 years (range 63-86). Mean age of the occlusion was 24.8 years. All patients had ischemia in the corresponding territory. Four of the patients had right coronary artery occlusions; one had a left circumflex occlusion and one had left anterior descending artery occlusion. Using a combination of radial and/or femoral approach, we successfully recanalized all of these old occlusions. No patients had major adverse cardiac events. Two patients developed restenosis at follow-up that was subsequently treated uneventfully. All the patients had a complete relief of angina. In a small single center experience, even very old occlusions >20-year old can be effectively treated with dedicated systems, excellent guiding catheter support and experienced physicians.