Percutaneous coronary intervention due to chronic total occlusion in the left main coronary artery after bypass grafting: A feasible option in selected cases Article Swipe
Eduardo Flores‐Umanzor
,
Victoria Martín‐Yuste
,
Guillem Caldentey
,
Sara Vázquez‐Calvo
,
Gustavo Jiménez-Brítez
,
Rodolfo San Antonio
,
Pedro Cepas‐Guillén
,
Margarida Pujol‐López
,
Marco Hernández
,
Manel Sabaté
·
YOU?
·
· 2018
· Open Access
·
· DOI: https://doi.org/10.1016/j.repce.2017.03.014
YOU?
·
· 2018
· Open Access
·
· DOI: https://doi.org/10.1016/j.repce.2017.03.014
Introduction: Chronic total occlusion (CTO) of the left main coronary artery (LMCA) is an infrequent finding. Revascularization is recommended in the presence of demonstrated viability or ischemia. Coronary artery bypass grafting (CABG) has long been considered the preferred option. Patients with previous CABG due to LMCA disease with occlusion of one graft and progression of the LMCA to CTO constitute a special population, as just one ischemic artery remains. For these patients, there is no other option for revascularization other than cardiac surgery (requiring resternotomy) or percutaneous coronary intervention (PCI) of the LMCA. Methods and Results: Out of 620 patients with CTO diagnosed in our center, we identified five with previous CABG due to LMCA disease for a retrospective case series. They had occlusion of one graft and progression of the LMCA to CTO. All five underwent PCI. Each patient received a functional classification for angina, myocardial ischemic tests, and a follow-up coronary angiogram during a median follow-up of 63 months. Coronary angiogram showed CTO of the semi-protected LMCA lesions with two CABGs previously performed in all patients, one occluded and the other patent. Three patients had occluded saphenous vein grafts to the circumflex coronary artery, and the rest had left internal mammary artery-left anterior descending artery CABG failure. Ischemia and viability were demonstrated. Surgery was ruled out due to high surgical risk. PCI due to CTO of the LMCA with drug-eluting stents was performed. In a five-year follow-up period, four patients remained asymptomatic and event free. One post-PCI death occurred from non-cardiovascular cause. Conclusions: PCI due to CTO of the LMCA following CABG can be successful and safe and can provide sustained clinical improvements in selected cases. Resumo: Introdução: A oclusão crónica total (OCT) do tronco comum (TC) coronário é um achado pouco frequente. A revascularização é recomendada na presença de viabilidade ou de isquemia comprovada. A coronary artery bypass grafting (CABG) tem sido durante muito tempo a opção preferencial. Os doentes com CABG prévia devida a doença do TC com oclusão de um enxerto e progressão para oclusão crónica total do tronco comum constituem uma população especial, uma vez que fica apenas uma artéria com isquemia. Para esses doentes não existe outra opção de revascularização além da cirurgia cardíaca – com necessidade de reesternotomia – ou a intervenção coronária percutânea do tronco comum. Métodos e resultados: Dos 620 doentes com oclusões coronárias totais diagnosticadas no nosso centro, identificamos como séries de casos retrospetivos, cinco com CABG prévia devida a doença do TC, que tinham uma oclusão de um enxerto e progressão da doença do TC para oclusão crónica total. Os cinco foram submetidos a intervenção coornária percutânea (ICP). Cada doente recebeu a classificação funcional de angina, de testes de isquemia do miocárdio e o seguimento com angiografía coronária durante o tempo médio de 63 meses de seguimento. O angiograma coronário mostrou oclusão coronária total das lesões semiprotegidas do TC com duas pontagens previamente feitas em todos os doentes, uma ocluída e a outra permeável. Três doentes tinham enxertos de veia safena para a artéria coronária circunflexa (Safena-CX) ocluídos e os restantes tinham insuficiência da pontagem com mamária interna esquerda para a artéria coronária descendente anterior (MIE-DA). Foi demonstrada isquemia ou viabilidade. A opção cirúrgica foi recusada devido ao elevado risco cirúrgico. Foi feita a ICP da oclusão coronária total do TC com stents revestidos de fármaco. Em cinco anos de seguimento, quatro doentes permaneceram assintomáticos e livres de eventos. Ocorreu uma morte após ICP devido a causa não cardiovascular. Conclusões: A ICP de oclusão crónica total do TC após CABG pode ser bem-sucedida, segura, e pode fornecer melhorias clínicas mantidas em casos selecionados. Keywords: Chronic total occlusion, Left main coronary artery, Coronary artery bypass grafting, Palavras-chave: Oclusão crónica total, Tronco comum coronário, Cirurgia coronária
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1016/j.repce.2017.03.014
- OA Status
- hybrid
- Cited By
- 1
- References
- 3
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4242056975
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4242056975Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1016/j.repce.2017.03.014Digital Object Identifier
- Title
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Percutaneous coronary intervention due to chronic total occlusion in the left main coronary artery after bypass grafting: A feasible option in selected casesWork title
- Type
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articleOpenAlex work type
- Language
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enPrimary language
- Publication year
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2018Year of publication
- Publication date
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2018-10-01Full publication date if available
- Authors
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Eduardo Flores‐Umanzor, Victoria Martín‐Yuste, Guillem Caldentey, Sara Vázquez‐Calvo, Gustavo Jiménez-Brítez, Rodolfo San Antonio, Pedro Cepas‐Guillén, Margarida Pujol‐López, Marco Hernández, Manel SabatéList of authors in order
- Landing page
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https://doi.org/10.1016/j.repce.2017.03.014Publisher landing page
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YesWhether a free full text is available
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hybridOpen access status per OpenAlex
- OA URL
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https://doi.org/10.1016/j.repce.2017.03.014Direct OA link when available
- Concepts
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Medicine, Conventional PCI, Cardiology, Percutaneous coronary intervention, Angina, Revascularization, Internal medicine, Artery, Circumflex, Surgery, Coronary artery disease, Myocardial infarctionTop concepts (fields/topics) attached by OpenAlex
- Cited by
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1Total citation count in OpenAlex
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2024: 1Per-year citation counts (last 5 years)
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.viabilidade. | 532 |
| abstract_inverted_index.Introduction: | 0 |
| abstract_inverted_index.Introdução: | 279 |
| abstract_inverted_index.bem-sucedida, | 594 |
| abstract_inverted_index.demonstrated. | 213 |
| abstract_inverted_index.identificamos | 399 |
| abstract_inverted_index.intervenção | 379, 436 |
| abstract_inverted_index.preferencial. | 320 |
| abstract_inverted_index.resternotomy) | 84 |
| abstract_inverted_index.retrospective | 118 |
| abstract_inverted_index.selecionados. | 604 |
| abstract_inverted_index.classification | 143 |
| abstract_inverted_index.diagnosticadas | 395 |
| abstract_inverted_index.insuficiência | 514 |
| abstract_inverted_index.reesternotomia | 375 |
| abstract_inverted_index.retrospetivos, | 404 |
| abstract_inverted_index.semi-protected | 167 |
| abstract_inverted_index.semiprotegidas | 478 |
| abstract_inverted_index.Palavras-chave: | 617 |
| abstract_inverted_index.assintomáticos | 566 |
| abstract_inverted_index.cardiovascular. | 580 |
| abstract_inverted_index.classificação | 444 |
| abstract_inverted_index.Revascularization | 16 |
| abstract_inverted_index.revascularization | 78 |
| abstract_inverted_index.non-cardiovascular | 252 |
| abstract_inverted_index.revascularização | 296, 366 |
| cited_by_percentile_year.max | 94 |
| cited_by_percentile_year.min | 90 |
| corresponding_author_ids | https://openalex.org/A5027869241 |
| countries_distinct_count | 1 |
| institutions_distinct_count | 10 |
| corresponding_institution_ids | https://openalex.org/I71999127 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/3 |
| sustainable_development_goals[0].score | 0.8600000143051147 |
| sustainable_development_goals[0].display_name | Good health and well-being |
| citation_normalized_percentile.value | 0.43513639 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | False |