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Percutaneous coronary intervention for three vessels of chronic total occlusion complicated with huge left

Sho Hashimoto1, Jun Shiraishi2, Takashi Yanagiuchi1

  • 1Department of Cardiology, Kyoto First Red Cross Hospital, Honmachi, Higashiyama-ku, Kyoto, 605-0981, Japan.

Cardiovascular Intervention and Therapeutics
|October 9, 2015
PubMed

Insights

Percutaneous coronary intervention successfully treated 3-vessel chronic total occlusion (CTO) in a heart failure patient. This intervention improved left ventricular (LV) function and resolved LV thrombus without complications.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiovascular Medicine

Background:

  • Ischemic cardiomyopathy presents significant challenges, often involving complex coronary artery disease.
  • Left ventricular (LV) thrombus formation is a serious complication, increasing embolic risk.
  • Severe LV dysfunction necessitates effective revascularization strategies.

Observation:

  • A 55-year-old woman presented with heart failure symptoms, diagnosed with ischemic cardiomyopathy, 3-vessel CTO, severely impaired LV function, and a large LV thrombus.
  • Anticoagulation therapy with warfarin, aspirin, and clopidogrel was initiated to manage the LV thrombus.
  • Percutaneous coronary intervention (PCI) was chosen over high-risk surgical options for CTO treatment.

Findings:

  • A hybrid antegrade/retrograde approach enabled successful PCI of the 3-vessel CTO.
  • Everolimus-eluting stents were implanted, achieving complete revascularization.
  • The procedure resulted in dramatically improved LV function and complete resolution of the LV thrombus, with no post-procedural embolism.

Implications:

  • Percutaneous coronary intervention is a viable and effective treatment for complex multi-vessel CTO in patients with severely reduced LV function and LV thrombus.
  • Successful revascularization can significantly improve cardiac function and reduce thrombus burden, offering an alternative to high-risk surgery.
  • This case highlights the importance of advanced PCI techniques in managing complex cardiovascular conditions, potentially improving patient outcomes and reducing embolic complications.

Keywords:
Chronic total occlusionEverolimus-eluting stentIschemic cardiomyopathyLeft ventricular thrombusPercutaneous coronary intervention

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