Abstract

Changing the geometry: Successful PCI of Chronic Total Occlusion (CTO) of Left Anterior Descending (LAD) artery: A case report

Author(s): Abdelaziz Ahmed Abdelaziz

Background: The treatment of Chronic Total Occlusions (CTOs) remains controversial, with various approaches ranging from medical therapy to revascularization strategies. In particular, the Left Anterior Descending (LAD) artery’s involvement necessitates careful consideration due to its significant role in myocardial perfusion. In this report, we highlight a successful intervention utilizing the Subintimal Tracking and Re-Entry (STAR) technique, which is particularly useful in cases where the proximal cap is ambiguous traditional wire escalation strategies are unsuccessful and balloon was used predilate the LAD-diagonal lesion to change the geometry of the lesion and to assist in further clarification of LAD stump.

Patient concerns: A male patient 47 years old, suffered from Hypertension (HTN), and dyslipidemia and had typical chest pain for the last couple of days on minimal exertion. The Electrocardiogram (ECG) and Echo revealed ischemic changes and regional wall motion abnormality.

Diagnosis: The coronary angiography results revealed an occluded LAD artery that is filling retrogradely from the Right Coronary Artery (RCA).

Interventions: Percutaneous angioplasty to LAD was done using dual injection and implantation of 2 Drug-Eluting Stents (DES) in LAD using the Subintimal Tracking and Re-Entry (STAR) technique.

Outcomes: Successful PCI to CTO LAD using 2 DES.

Conclusion: The successful utilization of the STAR technique, augmented by lesion geometry modification through balloon predilation, exemplifies the advancements in PCI strategies for CTO management.