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Interventional Management of Chronic Total Occlusion in the Left Main Coronary Artery
Yamama Hafeez* Vincent VargheseAbstract
Chronic total occlusion (CTO) of the left main coronary artery (LMCA) is a rare finding on angiograms, with coronary artery bypass grafting typically considered the standard approach for revascularization. To highlight the potential viability of percutaneous coronary intervention (PCI) as a safe alternative in select cases, we present a complex clinical case involving the revascularization of chronic total occlusions in the LMCA, left anterior descending artery (LAD), and circumflex artery (CX).
Methods: Recanalization of the occluded LMCA and LAD was achieved using a supportballoon technique and CTO wires (Miracle 3™ wire, Abbott Vascular; Runthrough® NS Intermediate wire, Terumo). Stenting was performed in the LAD, CX, LMCA, and its bifurcation using three drug-eluting stents (Resolute Integrity DES, Medtronic). Bifurcation stenting utilized the "Culotte Stenting" technique, followed by "Kissing Balloon" post-dilatation. Proximal optimization technique was applied in the LMCA.
Results: The intervention concluded without complications. Two months poststenting, the patient experienced an increase in ejection fraction from 20% to 38% and improvement in various cardiac parameters, resulting in a decrease in Congestive Heart Failure functional class to class I.
Conclusions: This case underscores the potential for successful revascularization of LMCA CTO lesions through PCI, provided appropriate patient selection and procedural techniques are employed.
