Technical Feasibility and Safety of Percutaneous Coronary Intervention for True Ostial Left Anterior Descending Artery-Chronic Total Occlusion
- Authors
- Yoon, Yong-Hoon; Lee, Pil Hyung; Park, Taek Kyu; Lee, Jang Hoon; Cho, Young-Rak; Suh, Jon; Roh, Jae-Hyung; Lee, Jae-Hwan; Yoon, Chang-Hwan; Hong, Young Joon; Lee, Cheol Hyun; Her, Sung-Ho; Chun, Kook-Jin; Yoo, Sang-Yong; Lee, Jong-Young; Lee, Seung-Whan
- Issue Date
- Mar-2021
- Publisher
- Pulsus Group Inc.
- Citation
- Canadian Journal of Cardiology, v.37, no.3, pp 458 - 466
- Pages
- 9
- Journal Title
- Canadian Journal of Cardiology
- Volume
- 37
- Number
- 3
- Start Page
- 458
- End Page
- 466
- URI
- https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/18955
- DOI
- 10.1016/j.cjca.2020.08.009
- ISSN
- 0828-282X
1916-7075
- Abstract
- Background: Percutaneous coronary intervention (PCI) for true ostial left anterior descending artery (LAD) -chronic total occlusion (CTO) lesions poses technical challenges owing to its inherent anatomic features. Methods: In total, 270 consecutive patients who underwent PCI for ostial LAD-CTO at 13 major cardiac centers in South Korea were included. Ostial LAD-CTO was strictly defined as a LAD-CTO lesion whose proximal cap was within 1 mm from the carina of the distal left main coronary artery (LMCA) bifurcation. Results: Ostial LAD-CTOs were frequently accompanied by stumpless lesion entry (43.4%), whereas significant bending within the occluded segment was less frequent (14.4%). The overall technical success rate was 85.9%, and serious in-hospital adverse events occurred in 5.6%. The retrograde approach tended to contribute more frequently to success in patients with concomitant LMCA disease, stumpless CTO, interventional collaterals, and higher Japanese-CTO scores. Apparent dissection or hematoma requiring rescue procedure at the LMCA or left circumflex artery occurred in 14 patients (5.2%), with a higher tendency in patients who had LMCA disease (12.1% vs 4.2%) and stumpless entry (9.4% vs 2.0%) than in those without. Among patients who were successfully treated, with an average of 1.7 stents, target vessel failure occurred in 23 patients (9.9%) during a median 3.3 years of follow-up. Conclusions: In this first large-scale analysis of true ostial LAD-CTO, PCI was feasible with a high technical success rate and favourable mid-term outcomes. Clinically relevant inflow vessel injury can occur during PCI and should be an important technical consideration regarding safety.
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