Abstract
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.
Highlights
According to the World Health Organization, in 2015, 17.7 million people died from cardiovascular diseases (CVDs), with 75% of deaths occurring in developing countries and low-income countries
To demonstrate that percutaneous coronary intervention (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 left main coronary artery (LMCA), left anterior descending (LAD) artery, and circumflex (CX) artery
Recanalization of the occluded LMCA and left anterior descending artery (LAD) was performed by utilizing the support-balloon technique, and chronic total occlusion (CTO) wires (Miracle 3TM wire, Abbott Vascular; Runthrough® NS Intermediate wire, Terumo); LAD, circumflex artery (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
Summary
According to the World Health Organization, in 2015, 17.7 million people died from cardiovascular diseases (CVDs), with 75% of deaths occurring in developing countries and low-income countries. Nowadays 17.9 million people die each year from CVDs, an estimated 31% of all deaths worldwide [12]. 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. At the same time, it is necessary to note, that despite the tremendous success PCI, are recorded many cases of CTO, where PCI attempts failed [6]
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