Surgery for Chronic Total Occlusion of the Left Main Stem: A 10-Year Experience

2009 ◽  
Vol 17 (5) ◽  
pp. 472-476 ◽  
Author(s):  
Raja Parvez Akhtar ◽  
Mumraiz Salik Naqshband ◽  
Abdul Rehman Abid ◽  
Zafar Tufail ◽  
Abdul Waheed ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Chronic Total Occlusion ◽  
Artery Bypass ◽  
Main Stem ◽  
Hospital Death ◽  
Left Main ◽  
Total Occlusion ◽  
Vessel Disease ◽  
Left Main Stem ◽  
Ischemic Attack

Chronic total occlusion of the left main stem coronary artery is rare. This retrospective study was conducted to evaluate outcomes of coronary artery bypass grafting between June 1998 and June 2008 in patients with chronic left main stem total occlusion. There were 17 (0.025%) cases detected in 67,082 coronary angiograms. The 14 men and 3 women had a mean age of 55.32 ± 9.2 years. Risk factors included diabetes in 8, hypertension in 6, and smoking in 6. Of 54 grafts applied, 15 were arterial and 39 were venous; 14 patients had 3-vessel disease, and 3 had 4-vessel disease. Three patients required intraaortic balloon counterpulsation perioperatively. The mean intensive care unit stay was 2.1 ± 1.2 days, and hospital stay was 7.1 ± 1.5 days. Postoperatively, one patient suffered myocardial infarction, another had a transient ischemic attack with spontaneous recovery, and 2 developed atrial fibrillation. There was no operative or hospital death. Surgical revascularization is considered appropriate treatment for chronic total occlusion of the left main stem.

scholarly journals Angiographic Severity of Coronary Artery Disease in Diabetic and Non-Diabetic Patients in a Tertiary Care Centre

2015 ◽  
Vol 10 (1) ◽  
pp. 13-17 ◽  
Author(s):  
Tanjima Parvin ◽  
KMHS Sirajul Haque ◽  
Md Abu Siddique ◽  
SM Ahsan Habib ◽  
Mukhlesur Rahman ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Main Stem ◽  
Diabetic Patients ◽  
Left Main ◽  
Coronary Syndrome ◽  
Vessel Disease ◽  
Left Main Stem ◽  
Severe Coronary Artery ◽  
Artery Disease

Objective: Diabetes mellitus, a common metabolic disorder, is often associated with severe coronary artery disease. In this study, we compared the angiographic severity of coronary artery disease in diabetic patients compared with that of non diabetic patients.Methods: This observational study comprised of 102 subjects who had coronary artery disease on coronary angiography in the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2009 to December 2009. The patients were divided into two groups: one group with 24 (23.5%) diabetic patients and another group with 78 (76.5%) non diabetic patients. Demographic, clinical, laboratory and angiographic data were analyzed and compared between two groups.Results: Mean age±SD of the study subjects was 52.8±9.5 years and 94 (92%) of them were male. Diabetic patients were older (mean age±SD; 57.6±9.5 versus 51.3±9.9 years; p 004), and had higher frequency of hypertension (75% versus 50%, p 0.036), chronic stable angina (71% versus 41%, p 0.018), and lower frequency of smoking (42% versus 67%, p 0.034) and acute coronary syndrome (29% versus 59%; p 0.018) in comparison to non diabetic patients. Left main stem disease (21% versus 5%, p 0.031) and three-vessel disease (50% versus 31%, p 0.094) were more prevalent in diabetic patients. Severe coronary artery stenosis was significantly more present in diabetics than non diabetics (Gensini score, 50.9±29.9 versus 32.6±21.9, p 0.001).Conclusion: Diabetic patients are more likely to have severe and extensive coronary artery disease. Left main stem and triple vessel disease are more commonly seen in diabetic patients compared to non diabetic patients.University Heart Journal Vol. 10, No. 1, January 2014; 13-17

Chronic Effort-Induced Angina as Presentation of a Totally Occluded Left Main Coronary Artery: A Case Report and Review

Angiology ◽  
2008 ◽  
Vol 60 (3) ◽  
pp. 382-384 ◽  
Author(s):  
Nancy K. Koster ◽  
Michael White
Keyword(s):  
Coronary Artery ◽  
Collateral Circulation ◽  
Chronic Total Occlusion ◽  
Left Main Coronary Artery ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Left Main ◽  
Total Occlusion ◽  
Rare Finding ◽  
The Right

In this report, the case of a 40-year-old patient with chronic total occlusion of the left main coronary artery is discussed. Total occlusion of the left main coronary artery is a rare finding at coronary angiography. When present, patients most often have extensive collateral circulation from the right coronary artery. The mainstay of treatment is surgical with coronary artery bypass grafting.

scholarly journals Revascularisation of left main stem disease: a prospective analysis of modern practice and outcomes in a non-surgical centre

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000804
Author(s):  
J J Coughlan ◽  
Nial Blake ◽  
Napohn Chongprasertpon ◽  
Munir Ibrahim ◽  
Samer Arnous ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Main Stem ◽  
Left Main ◽  
Clinical Registry ◽  
Left Main Stem ◽  
Modern Drug ◽  
Artery Disease ◽  
Left Main Stem Disease

PurposeIn this study, we sought to prospectively analyse the management and long term outcomes associated with revascularisation of left main stem disease via percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in our centre.MethodsThis prospective study enrolled all patients with unprotected left main stem disease undergoing revascularisation from January 2013 to June 2014. Baseline characteristics, hospital presentation and hospital stay length were collected. Patients were followed up at 1, 2 and 3 years. Primary outcomes of Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) were defined as death, Q wave myocardial infarction, stroke, repeat revascularisation and readmission within 30 days.Results56 patients with significant left main stem coronary artery disease were identified from the clinical registry. 27 patients underwent PCI (median age 67.7) and 29 CABG (median age 68.6). PCI patients had a higher surgical risk as measured by mean euroSCORE (4.95±5.8 vs 3.11±3.85). At 3 years, total MACCE occurred in 29.6% of the PCI cohort and 27.5% of the CABG cohort. Death occurred in three patients in the PCI group within the first 6 months. Death occurred in one patient in the CABG group over 2 years postprocedure. Two patients in the CABG cohort presented with Transient Ischemic Attacks (TIAs) at 2-year follow-up. At 3 years, revascularisation occurred in three patients in the PCI cohort. There were no revascularisation events in the CABG cohort.ConclusionsPCI with modern drug eluting stents is a reasonable treatment option for unprotected left main stem disease in a non surgical centre.

Off-Pump coronary artery bypass (OPCAB) in significant left main stem stenosis

2004 ◽  
Vol 20 (1) ◽  
pp. 6-6
Author(s):  
P K Rath ◽  
R Mehrotra ◽  
S Vanzara ◽  
U Patil ◽  
S Vaishnav ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Main Stem ◽  
Left Main ◽  
Off Pump ◽  
Left Main Stem ◽  
Pump Coronary Artery Bypass

scholarly journals Percutaneous Intervention of Left Main Coronary Artery Chronic Total Occlusion

2019 ◽  
Vol 1 (3) ◽  
pp. 19-27
Author(s):  
Murman Kantaria ◽  
Murman Kantaria ◽  
Murman Kantaria ◽  
Vazha Agladze ◽  
Pavle Machavariani ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Chronic Total Occlusion ◽  
Left Main Coronary Artery ◽  
Artery Bypass ◽  
Optimization Technique ◽  
Functional Class ◽  
Left Main ◽  
Circumflex Artery ◽  
Total Occlusion ◽  
Almost All

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.

scholarly journals Pattern of left main stenosis at a tertiary cardiac center of Nepal

2017 ◽  
Vol 14 (1) ◽  
pp. 29-30
Author(s):  
Binay Kumar Rauniyar ◽  
Milan Gautam ◽  
Ranjit Sharma ◽  
Subodh Bir Singh Kansakar ◽  
Rajib Rajbhandari ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Main Stem ◽  
Left Main ◽  
Vessel Disease ◽  
Left Main Stem ◽  
Triple Vessel Disease ◽  
Cardiology Department ◽  
Artery Disease ◽  
Cardiac Center ◽  
Left Main Stem Disease

Background and Aims: Left main stem stenosis is defined as a lesion occupying more than 50% of the lumen diameter. Various studies have shown that left main stem stenosis occurs in 4%-6% of all the patients undergoing coronary angiography. We aim to find out the pattern of Left main stem disease in cardiology department of a tertiary cardiac center of Nepal.Methods: This was a retrospective study and was conducted from the properly maintained record of 2 years (August 2011 to July 2013) from cardiaccatheterization labs of Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal.Results: During the study period 3290 coronary angiogram were done. Among them 102 (3.1%) patients had left main stem stenosis of more than 50%. Mean age of the patients with left main stem stenosis was 60.6±10.1yrs. Most of (73.5%) of patients with left main stem stenosis were of age more than 55 years. Most (80.3%) of them were male. Ostial left main stem stenosis was present in 32 (31.3%) patients whereas distal left main stem stenosis was present in 70 (68.6%) patients. In patients with Left main stem stenosis, single vessel disease was present in 12 (11.7%), double vessel disease in 33(32.3%) and triple vessel disease in 49 (48.0%) patients, whereas 8 (7.8%) patients with non-critical coronary artery disease.Conclusion: Left main stem disease is not an uncommon angiographic finding and is often associated with multivessel coronary artery disease. It commonly occurs in distal part of vessel and the patients were older males.Nepalese Heart Journal 2017; 14(1): 29-30

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