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Progressive Collateral Stenosis Leading to Symptomatic Chronic Total Occlusion
Farhan A Shah1, Andrew Maiolo2
1Internal Medicine, LewisGale Medical Center, Salem, USA.
Cureus
|February 10, 2021
Summary
This case highlights a 79-year-old woman with new-onset angina due to chronic total occlusion (CTO) of the right coronary artery. Percutaneous coronary intervention (PCI) successfully restored blood flow, demonstrating angioplasty
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Chronic total occlusion (CTO) of coronary arteries is common, yet percutaneous coronary intervention (PCI) rates remain low due to perceived risks.
- Robust collateral circulation can mask CTO symptoms, leading to delayed presentation.
Observation:
- A 79-year-old female presented with new-onset angina and numbness, despite no prior history of coronary artery disease.
- Diagnostic angiography revealed a chronic total occlusion of the mid-right coronary artery, with collateral supply to the distal territory.
- Left anterior descending artery stenosis was identified as the cause of inadequate collateralization and subsequent CTO symptoms.
Findings:
- Percutaneous coronary intervention (PCI) with successful implantation of two drug-eluting stents was performed.
- The final angiographic result showed 0% residual stenosis and Thrombolysis in Myocardial Infarction (TIMI)-3 flow, indicating successful revascularization.
- The patient's symptoms resolved post-PCI.
Implications:
- This case underscores the safety and efficacy of PCI for treating coronary artery CTO, even in elderly patients with complex presentations.
- It reinforces the importance of considering angioplasty for CTO to alleviate angina and improve outcomes.
- Further research and clinical adoption of PCI for CTO are warranted to improve patient care.
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