Left Main Chronic Total Occlusion Percutaneous Coronary Intervention: A Case Series

Left main coronary artery (LMCA) chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. We reviewed 4436 CTO-PCIs performed in 4340 patients between 2012 and 2018 at 25 sites. LMCA-CTO-PCI was performed in 20 cases (0.45%). We examined the clinical and ang...

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Veröffentlicht in:The Journal of invasive cardiology 2019-07, Vol.31 (7), p.E220
Hauptverfasser: Xenogiannis, Iosif, Karmpaliotis, Dimitri, Alaswad, Khaldoon, Basir, Mir B, Yeh, Robert W, Tamez, Hector, Patel, Mitul, Mahmud, Ehtisham, Choi, James W, Burke, M Nicholas, Doing, Anthony H, Dattilo, Phil, Khatri, Jaikirshan J, Sheikh, Abdul M, Malik, Bilal A, Greene, Mary E, Abi Rafeh, Nidal, Maalouf, Assaad, Abou Jaoudeh, Fadi, Moses, Jeffrey W, Lembo, Nicholas J, Parikh, Manish, Kirtane, Ajay J, Ali, Ziad A, Gkargkoulas, Fotis, Russo, Juan, Hakemi, Emad, Tajti, Peter, Hall, Allison B, Vemmou, Evangelia, Nikolakopoulos, Ilias, Rangan, Bavana V, Abdullah, Shuaib, Banerjee, Subhash, Brilakis, Emmanouil S
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Sprache:eng
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Zusammenfassung:Left main coronary artery (LMCA) chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. We reviewed 4436 CTO-PCIs performed in 4340 patients between 2012 and 2018 at 25 sites. LMCA-CTO-PCI was performed in 20 cases (0.45%). We examined the clinical and angiographic characteristics and procedural outcomes of these cases. Mean patient age was 68 ± 11 years and 65% were men. Most patients (85%) had undergone prior coronary artery bypass graft surgery and had a protected left main. Mean J-CTO score was 2.7 ± 1.3, mean PROGRESS-CTO score was 1.3 ± 1.1, and mean PROGRESS-CTO Complications score was 3.8 ± 1.9. Antegrade-wire escalation was the most common successful crossing strategy (50%), followed by retrograde crossing (30%) and antegrade dissection/re-entry (10%). Technical and procedural success rates were both 85%. One patient with failed LMCA-CTO-PCI had periprocedural myocardial infarction. Median procedure time was 178 minutes (interquartile range [IQR], 123-250 minutes), median contrast volume was 190 mL (IQR, 133-339 mL), and patient air kerma radiation dose was 2.6 Gray (IQR, 1.3-3.9 Gray). LMCA-CTO-PCI is infrequent, is performed mostly in patients with prior coronary artery bypass graft surgery, and is associated with good procedural outcomes.
ISSN:1557-2501