Left Main Chronic Total Occlusion Percutaneous Coronary Intervention: A Case Series.

Xenogiannis, Iosif

Left Main Chronic Total Occlusion Percutaneous Coronary Intervention: A Case Series.

Tuesday, May 21, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Iosif Xenogiannis, M.D. , ACIST Medical Systems, Dallas, TX

Dimitrios Karmpaliotis, M.D. , Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, NY

Khaldoon Alaswad, M.D., FSCAI , Henry Ford Health System, Detroit, MI

Mir B. Basir, D.O., FSCAI , Henry Ford Health System, Detroit, MI

Robert W. Yeh, M.D., FSCAI , Beth Israel Deaconess Medical Center, Boston, MA

Hector Tamez, M.D., FSCAI , Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA

Mitul P. Patel, M.D., FSCAI , UCSD Medical Center, San Diego, CA

Ehtisham Mahmud, M.D., FSCAI , University of California, San Diego Sulpizio Cardiovascular Center, San Diego, CA

James W. Choi, M.D., FSCAI , Cardiology Consultants of Texas, Dallas, TX

M. Nicholas Burke, M.D., FSCAI , Minneapolis Heart Institute, Minneapolis, MN

Anthony Doing, MD , Medical Center of the Rockies, Loveland, CO

Philip Dattilo, M.D., FSCAI , University of Colorado Health North, Fort Collins, CO

Jaikirshan Khatri, M.D., FSCAI , Cardiovascular Medicine Associates, Inc., Cleveland, OH

Abdul M Sheikh, M.D. , none, Atlanta, GA

Bilal A. Malik, M.D., FSCAI , Maimonides Medical Center, Brooklyn, Brooklyn, NY

Mary Greene, M.D. , Maimonides Medical Center, Brooklyn, Brooklyn, NY

Nidal Abi Rafeh, M.D. , TULANE UNIVERSITY SCHOOL OF MEDICINE, Metairie, LA

Asaad Maallouf, M.D. , St. George University Hospital Center, Beirut, Lebanon

Fadi Abou Jaoudeh, M.D. , St. George University Hospital Center, Beirut, Lebanon

Jeffrey W. Moses, M.D., FSCAI , Columbia University Medical Center, New York, NY

Nicholas Joseph Lembo, M.D., FSCAI , Center for Interventional Vascular Therapy, Columbia University Medical Center, Alys Beach, FL

Manish A. Parikh, M.D., FSCAI , Columbia University/NY Presbyterian Hospital, New York, NY

Ajay J. Kirtane, M.D., FSCAI , Columbia University Medical Center, Demarest, NJ

Ziad A. Ali, M.D., Ph.D. , Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, NY

Fotis Gkargkoulas, M.D. , Columbia University Medical Center, New York, NY

Juan Russo, M.D. , Columbia University Medical Center, New York, NY

Emad Uddin Hakemi, M.D. , Columbia University/NY Presbyterian Hospital, New Yrok, NY

Peter Tajti, M.D. , Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN

Allison Barbara Hall, M.D. , Memorial University of Newfoundland, Portugal Cove-St. Philip's, NF, Canada

Evangelia Vemmou, M.D. , Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN

Ilias Nikolakopoulos, M.D. , Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN

Bavana Rangan, BDS, MPH , Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN

Shuaib Abdullah, M.D. , VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX

Subhash Banerjee, M.D., FSCAI , Dallas Veterans Affairs Medical Center, Dallas, TX

Emmanouil S. Brilakis, M.D., FSCAI , Minneapolis Heart Institute, Minneapolis, MN

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.