Percutaneous intervention of left main coronary artery chronic total occlusion: A case report.
Ontology highlight
ABSTRACT:
SUBMITTER: Coksevim M
PROVIDER: S-EPMC5998863 | biostudies-literature | 2018 Jun
REPOSITORIES: biostudies-literature
Publications
Percutaneous intervention of left main coronary artery chronic total occlusion: A case report.
Çoksevim Metin M Akçay Murat M Soylu Korhan K Göktekin Ömer Ö
Anatolian journal of cardiology 20180601 6
Similar Datasets
Project description:Abstract Background Percutaneous coronary intervention (PCI) via left internal mammary artery (LIMA) graft is technically challenging, requires special consideration due to association with potential complications and therefore, infrequently performed. Data on in-stent chronic total occlusion (CTO) PCI via the LIMA graft is even rarer. Case summary A 59-year-old male with a background history of coronary artery bypass graft surgery and previous PCI, presented with progressive chest pain on mild exertion, in the setting of a chronic coronary syndrome. Transradial coronary angiography revealed significant native three-vessel disease with CTO of right coronary, left anterior descending (LAD) and left circumflex arteries. Left internal mammary artery-LAD was widely patent. The previous LIMA-LAD stent at the anastomosis had a CTO with severe in-stent restenosis (ISR) at the distal end of the stent in the native LAD. The distal LAD was filled from bridging collaterals. Following discussion at the heart team meeting, he underwent successful complex PCI of LAD CTO via the LIMA graft at the site of ISR of previous LIMA-LAD anastomosis stent, which was finally treated with drug-coated balloon (DCB) angioplasty. Discussion Recurrent angina post-coronary revascularization can be very challenging to manage by medical therapy alone. Percutaneous intervention of complex coronary lesions in these patients requires experience and skill, especially when approaching lesions using the LIMA as a conduit. The use of DCB for ISR management is a well-known strategy; however, adequate lesion preparation is the key to satisfactory outcome.
| S-EPMC8874813 | biostudies-literature
Project description:BackgroundEngagement of the guiding catheter (GC) for the coronary artery is sometimes difficult, depending on the patient's anatomy. The most suitable GC before percutaneous coronary intervention (PCI) in individual cases has not been determined yet.Case summaryAn 81-year-old woman who had a right coronary artery chronic total occlusion had difficulty to engage the catheter for the right coronary artery in the first examination. Virtual reality (VR)-guided GC simulation before PCI using cardiac computed tomography (CT) could overcome the difficulty of GC engagement for the coronary artery and achieve procedure success.DiscussionVR-guided GC simulation has the potential to solve the catheter approach difficulty for any cardiovascular intervention.
| S-EPMC10606233 | biostudies-literature
Project description:BackgroundIatrogenic left main coronary artery dissection is a rare but serious complication that can occur both during diagnostic coronary angiography and percutaneous coronary intervention. Early diagnosis and choice of optimal management are of crucial importance for patient's outcome while representing a challenge for clinicians.Case presentationWe present a case of iatrogenic left main coronary artery dissection occurring during diagnostic coronary angiography in a 53-year-old Greek woman with a history of coronary artery bypass grafting. Although dissection was greatly extending to mid left anterior descending artery, delayed percutaneous coronary intervention was successfully performed by carefully wiring the true lumen.ConclusionsDelayed percutaneous coronary intervention, performed 25 days following the index event, proved to be a feasible and effective strategy for treating a widely extended left main coronary artery iatrogenic dissection.
| S-EPMC9743719 | biostudies-literature
Project description:Our aim was to evaluate the feasibility and safety of routine transradial approach (TRA) percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions using the sheathless technique with standard guiding catheters.Transradial approach PCI was applied for CTO lesions. A major limitation of TRA CTO PCI is the inability to use large guiding catheters because of the relatively small size of the radial artery. Therefore, the sheathless technique for TRA PCI has been recently developed. However, reports on TRA CTO PCI using the sheathless technique are still lacking.Sixty-eight patients with CTO lesions were enrolled for TRA PCI using the sheathless technique with standard guiding catheters. The baseline characteristics, coronary angiographic characteristics and major procedure or access site related complications were compared between procedure success and procedure failure group to determine the predictors of success in sheathless CTO PCI. In-hospital and 30-day clinical outcomes were also evaluated in this study. Routine assessments of radial artery occlusion via Doppler ultrasound and pulse oximeter were recorded during one-year clinical follow-up.The mean duration of CTO by history was 31.8 ± 42.3 months. The 7 Fr standard guiding catheter was used with the sheathless technique in 91.2%, and bilateral sheathless approach in 42.6% of the study patients. The procedure-related complications included coronary perforation needing covered stent deployment (2.9%), cardiac tamponade (2.9%), collateral perforation needing coil deployment (4.4%), and contrast induced nephropathy (2.9%). Only 2 patients (2.9%) experienced forearm ecchymosis at the radial artery access sites. In-hospital mortality and 30-day all-cause mortality were 2.9%, and 30-day MACEs were 1.5%. The rate of radial artery occlusion during one-year clinical follow-up was only 3.0%.It is feasible and safe to routinely use the sheathless technique with standard guiding catheters for TRA CTO PCI, with a low incidence of procedure-related complications and long-term radial artery occlusion.
| S-EPMC5497147 | biostudies-other
Project description:BackgroundA single coronary artery ostium (SCAO) is estimated to be present in 0.066% of the general population. The proximal coronary course and the relationship with surrounding structures are related to malignant vs. benign prognoses. We present a case of SCAO with the right coronary artery (RCA) arising from the mid-left anterior descending (LAD), complicated by anterior and inferior STEMI because of acute thrombotic occlusion at the bifurcation and its percutaneous management.Case summaryA 56-year-old male was admitted with sudden onset of resting chest pain. His ECG showed an anterior, inferior, and right ventricular STEMI. Via trans-radial access, coronary angiography showed significant stenoses at the left main and the circumflex but also a thrombotic occlusion at the proximal segment of the LAD while no RCA was seen. After crossing the LAD occlusion, the dominant RCA appeared from the mid-LAD. A provisional stent technique was performed achieving good results. Coronary computed tomography angiography showed an SCAO congenital anomaly with a patent stent in the bifurcation accompanied by diffuse coronary artery disease causing mild stenosis of the left main, proximal, and distal circumflex.DiscussionThe RCA arising from the mid-LAD with pre-pulmonic course has been described in only 37 cases. One reported an LAD/RCA bifurcation treatment with two stents technique in a stable scenario. The present is the first case reported of an acute thrombotic occlusion of an LAD/RCA bifurcation clinically resulting in a left main equivalent STEMI treated successfully with primary percutaneous coronary intervention using a bifurcation technique.
| S-EPMC7780483 | biostudies-literature
Project description:Owing to a large-jeopardized myocardium, left main coronary artery disease (LMCAD) represents the substantial high-risk anatomical subset of obstructive coronary artery disease. For several decades, coronary artery bypass grafting (CABG) has been the "gold standard" treatment for LMCAD. Along with advances in CABG, percutaneous coronary intervention (PCI) has also dramatically evolved over time in conjunction with advances in the stent or device technology, adjunct pharmacotherapy, accumulated experiences, and practice changes, establishing its position as a safe, reasonable treatment option for such a complex disease. Until recently, several randomized clinical trials, meta-analyses, and observational registries comparing PCI and CABG for LMCAD have shown comparable long-term survival with tradeoffs between early and late risk-benefit of each treatment. Despite this, there are still several unmet issues for revascularization strategy and management for LMCAD. This review article summarized updated knowledge on evolution and clinical evidence on the treatment of LMCAD, with a focus on the comparison of state-of-the-art PCI with CABG.
| S-EPMC10011221 | biostudies-literature
Project description:We report the case of a young woman with chest pain and recurrent abortion. The patient was found to have Takayasu arteritis. Drug therapy was started, and emergency bypass surgery was performed. The case showed the possible clinical manifestation of vasculitis as a recurrent abortion, followed by total occlusion of the left main coronary artery. (Level of Difficulty: Intermediate.).
| S-EPMC8298299 | biostudies-literature
Project description:ObjectivesThis study evaluated myocardial viability as well as global and regional functional recovery after successful chronic coronary total occlusion (CTO) percutaneous coronary intervention (PCI) using sequential quantitative cardiac magnetic resonance (CMR) imaging.BackgroundThe patient benefits of CTO PCI are being questioned.MethodsIn a single high-volume CTO PCI center patients were prospectively scheduled for CMR at baseline and 3 months after successful CTO PCI between 2013 and 2018. Segmental wall thickening (SWT) and percentage late gadolinium enhancement (LGE) were quantitatively measured per segment. Viability was defined as dysfunctional myocardium (<2.84 mm SWT) with no or limited scar (≤50% LGE).ResultsA total of 132 patients were included. Improvement of left ventricular ejection fraction was modest after CTO PCI (from 48.1 ± 11.8 to 49.5 ± 12.1%, p < 0.01). CTO segments with viability (N = 216, [31%]) demonstrated a significantly higher increase in SWT (0.80 ± 1.39 mm) compared to CTO segments with pre-procedural preserved function (N = 456 [65%], 0.07 ± 1.43 mm, p < 0.01) or extensive scar (LGE >50%, N = 26 [4%], -0.08 ± 1.09 mm, p < 0.01). Patients with ≥2 CTO segments viability showed more SWT increase in the CTO territory compared to patients with 0-1 segment viability (0.49 ± 0.93 vs. 0.12 ± 0.98 mm, p = 0.03).ConclusionsDetection of dysfunctional myocardial segments without extensive scar (≤50% LGE) as a marker for viability on CMR aids in identifying patients with significant regional functional recovery after CTO PCI.
| S-EPMC9291134 | biostudies-literature
Project description:BackgroundSimultaneous thrombosis in more than one coronary artery is an uncommon angiographic finding in patients with acute ST-segment elevation myocardial infarction. It is difficult to identify using 12-lead electrocardiography and usually leads to cardiogenic shock and fatal outcomes, including sudden cardiac death. Therefore, immediate revascularization and adequate mechanical circulatory support are required.Case presentationWe report the case of a 58-year-old man who presented with vomiting and chest pain complicated by cardiogenic shock and complete atrioventricular block. Electrocardiography revealed ST-segment elevation in leads II, III, aVF, and V1-V6. Emergency coronary angiography revealed total occlusion of the proximal left anterior descending artery and right coronary artery. The patient successfully underwent primary percutaneous coronary intervention with ballooning and stenting for both arteries. An Impella CP was inserted during the procedure. Fifty-seven days after admission, he had New York Heart Association class II heart failure and was transferred to a rehabilitation hospital.ConclusionsAcute double-vessel coronary thrombosis, a serious event with a high mortality rate, requires prompt diagnosis and management to prevent complications such as cardiogenic shock and ventricular arrhythmias. A combination of judicious medical treatment, efficient primary percutaneous coronary intervention, and early mechanical support device insertion is crucial to improve the survival rate of patients with this disease.
| S-EPMC9088105 | biostudies-literature
Project description:For several decades, coronary artery bypass grafting has been regarded as the standard choice of revascularization for significant left main coronary artery (LMCA) disease. However, in conjunction with remarkable advancement of device technology and adjunctive pharmacology, percutaneous coronary intervention (PCI) offers a more expeditious approach with rapid recovery and is a safe and effective alternative in appropriately selected patients with LMCA disease. Several landmark randomized clinical trials showed that PCI with drug-eluting stents for LMCA disease is a safe option with similar long-term survival rates to coronary artery bypass grafting surgery, especially in those with low and intermediate anatomic risk. Although it is expected that the updated evidence from recent randomized clinical trials will determine the next guidelines for the foreseeable future, there are still unresolved and unmet issues of LMCA revascularization and PCI strategy. This paper provides a comprehensive review on the evolution and an update on the management of LMCA disease.
| S-EPMC9627854 | biostudies-literature