A 43-Year-Old Male With Progressive Angina and Dyspnea on Exertion
A 43-year-old male presents for worsening angina and dyspnea on exertion and pre-operative cardiac evaluation prior to spinal surgery. His history is notable for a prior myocardial infarction. At that time the right coronary artery (infarct related artery) was treated with PCI with a drug eluting stent and a chronic total occlusion (CTO) of the mid left anterior descending (LAD) artery was identified. His other risk factors include hypertension, hyperlipidemia, diabetes mellitus type 2 and tobacco use. He underwent stress echocardiography that demonstrated hypokinesis along the left anterior descending artery distribution and left ventricular ejection fraction at rest of 55%. A subsequent coronary angiography demonstrated an occluded mid left anterior descending artery (LAD) with significant filling via right to left collaterals and patent right coronary artery stent. He was referred for evaluation for coronary artery pass surgery (CABG), but patient declined.
During the current presentation, he reports daily exertional class CCS III angina with progressive worsening despite maximal medical therapy.
Blood pressure was 118/70, heart rate 80 and body mass index 26 kg/m2. Physical exam was otherwise unremarkable.
After discussion with patient, a decision was made to proceed with proceed with percutaneous revascularization of the mid LAD CTO. As demonstrated in the video clips (Video 1, Video 2), a successful complex percutaneous coronary intervention (PCI) was performed with excellent results.
Which of the following is true regarding coronary chronic total occlusions and percutaneous revascularization of CTOs?