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Treatment option approaches to the management of chronic total occlusions

Shigeru Saito1

  • 1Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, 247-8533, Japan, cto.expert@gmail.com.

Current Treatment Options in Cardiovascular Medicine
|December 3, 2010
PubMed

Insights

This case study discusses treatment options for severe effort angina in a patient with prior coronary artery bypass graft (CABG) surgery. Percutaneous coronary intervention (PCI) is proposed for chronic total occlusion of the native right coronary artery (RCA).

Area of Science:

  • Cardiology
  • Interventional Cardiology

Background:

  • A 67-year-year-old patient presents with severe effort angina refractory to medical management.
  • The patient has a history of coronary artery bypass graft (CABG) surgery over 10 years prior.
  • Graft occlusion (saphenous vein graft [SVG] to right coronary artery [RCA] and SVG to circumflex artery) is noted, with a patent left internal mammary artery graft to the left anterior descending artery.

Purpose of the Study:

  • To evaluate treatment strategies for patients with severe angina and complex coronary artery disease.
  • To consider options for managing chronic total occlusion (CTO) of the native right coronary artery (RCA) in a patient with failed bypass grafts.

Main Methods:

  • Review of treatment options including repeat coronary artery bypass graft (redo CABG) versus percutaneous coronary intervention (PCI).
  • Focus on percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) of the native right coronary artery (RCA).

Main Results:

  • The patient's native RCA has been occluded since before the initial CABG surgery.
  • Previous SVG grafts to the RCA and circumflex artery have occluded.
  • The left internal mammary artery (LIMA) graft to the left anterior descending (LAD) artery remains patent.

Conclusions:

  • Percutaneous coronary intervention (PCI) is proposed as a viable treatment option for chronic total occlusion (CTO) of the native right coronary artery (RCA) in this complex patient.
  • This approach offers an alternative to redo CABG in select cases of refractory angina with CTO.
Abstract

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