Left main chronic total occlusion percutaneous coronary intervention: A case series

Background: Left main coronary artery (LMCA) chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. Methods: We reviewed between 2012 and 2018 4,436 CTO PCIs performed in 4,340 patients at 25 sites in the US, Europe and Asia, of which LMCA CTO PCI was performed in 20 (0.45%) cases at 11 sites. We examined the clinical and angiographic characteristics and procedural outcomes of these cases. Results: Mean patient age was 68±11 and 65% were men. Most patients (85%), had undergone prior coronary artery bypass surgery (CABG) and had patent grafts to the left anterior descending or circumflex artery. Mean J-CTO score was 2.7±1.3. Antegrade wire escalation (AWE) was the crossing strategy that was used more often (90%), followed by retrograde crossing (50%) and antegrade dissection/reentry (ADR) (15%). The most common successful crossing technique was AWE (50%), followed by retrograde crossing (30%) and ADR (10%). Technical and procedural success rates were 85% for both endpoints while only one in-hospital major adverse cardiac event was recorded: a periprocedural myocardial infarction (Figure 1). In addition, three patients had perforation that was treated conservatively without pericardiocentesis or emergent surgery and one patient developed a femoral pseudoaneurysm that was corrected surgically. A left ventricular assist device was used in 20%. Median procedure time was 178 (123, 250) min, median contrast volume was 190 (133, 339) ml and patient air kerma radiation dose was 2.6 (1.3, 3.9) Gray. Conclusions: LMCA CTO PCI is infrequently performed but is associated with good procedural outcomes. (Figure Presented)