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Case Reports
. 2018 Aug 23;8(4):223-226.
doi: 10.1080/20009666.2018.1490140. eCollection 2018.

Delayed spontaneous recanalization of chronic total occlusion of left anterior descending artery after attempted but failed revascularization during percutaneous coronary intervention

Nirmal Guragai  1 , Upamanyu Rampal  1 , Rahul Vasudev  1 , Hiten Patel  1 , Hashita Diana Manohar  2 , Pragya Bhandari  3 , Mahesh Bikkina  1 , Fayez Shamoon  1 , Hartaj Virk  1
Affiliations
Case Reports

Delayed spontaneous recanalization of chronic total occlusion of left anterior descending artery after attempted but failed revascularization during percutaneous coronary intervention

Nirmal Guragai et al. J Community Hosp Intern Med Perspect. .

Abstract

Chronic total occlusion (CTO) of coronary artery remains the Achilles heel of the interventional cardiologist and is present in a significant proportion of referrals for coronary artery bypass graft surgery (CABG); however, with the development and standardization of modern CTO recanalization techniques, it has been able to achieve excellent success while coping with lesions of increasing complexity. Nevertheless, failure to recanalize despite the development of new techniques still remains one of the challenges in the field of interventional cardiology. Spontaneous recanalization has been described in nonocclusive coronary artery dissections in detail; none has addressed the possibility of spontaneous recanalization after failed percutaneous coronary intervention (PCI). We report a case of spontaneous but delayed recanalization of CTO of left anterior descending artery 3 years after attempted but failed revascularization during PCI.

Keywords: Chronic total occlusion; delayed spontaneous recanalization; microdissection; percutaneous coronary intervention; revascularization.

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Figures

Figure 1.
Figure 1.
Panel A, C, and E with right anterior oblique projection showing mid left anterior descending (LAD) artery chronic total occlusion (CTO) stump, unable to cross XYZ wire into true lumen of LAD artery distal to CTO stump, and spontaneous recanalization after 3 years, respectively. Panel B, D, and F with anterio-posterior cranial view showing attempted antegrade crossing of CTO with XYZ wire, unchanged LAD artery stump CTO after attempted antegrade wire crossing and spontaneously recanalized LAD artery 3 years after attempted wire crossing, respectively. (LCx: Left Circumflex).
See this image and copyright information in PMC

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