Left main chronic total occlusion percutaneous coronary intervention: A case series

Iosif Xenogiannis, Dimitri Karmpaliotis, Khaldoon Alaswad, Mir B. Basir, Robert W. Yeh, Hector Tamez, Mitul Patel, Ehtisham Mahmud, James W. Choi, M. Nicholas Burke, Anthony H. Doing, Phil Dattilo, Jaikirshan J. Khatri, Abdul M. Sheikh, Bilal A. Malik, Mary E. Greene, Nidal Abi Rafeh, Assaad Maalouf, Fadi Abou Jaoudeh, Jeffrey W. MosesNicholas J. Lembo, Manish Parikh, Ajay J. Kirtane, Ziad A. Ali, Fotis Gkargkoulas, Juan Russo, Emad Hakemi, Peter Tajti, Allison B. Hall, Evangelia Vemmou, Ilias Nikolakopoulos, Bavana Venkata Rangan, Shuaib Abdullah, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background. Left main coronary artery (LMCA) chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study. Methods. We reviewed 4436 CTO-PCIs performed in 4340 patients between 2012 and 2018 at 25 sites. LMCA-CTO-PCI was performed in 20 cases (0.45%). We examined the clinical and angiographic characteristics and procedural outcomes of these cases. Results. Mean patient age was 68 ± 11 years and 65% were men. Most patients (85%) had undergone prior coronary artery bypass graft surgery and had a protected left main. Mean J-CTO score was 2.7 ± 1.3, mean PROGRESS-CTO score was 1.3 ± 1.1, and mean PROGRESS-CTO Complications score was 3.8 ± 1.9. Antegrade-wire escalation was the most common successful crossing strategy (50%), followed by retrograde crossing (30%) and antegrade dissection/re-entry (10%). Technical and procedural success rates were both 85%. One patient with failed LMCA-CTO-PCI had periprocedural myocardial infarction. Median procedure time was 178 minutes (interquartile range [IQR], 123-250 minutes), median contrast volume was 190 mL (IQR, 133-339 mL), and patient air kerma radiation dose was 2.6 Gray (IQR, 1.3-3.9 Gray). Conclusions. LMCA-CTO-PCI is infrequent, is performed mostly in patients with prior coronary artery bypass graft surgery, and is associated with good procedural outcomes.

Original languageEnglish (US)
Pages (from-to)E220-E225
JournalJournal of Invasive Cardiology
Issue number7
StatePublished - 2019


  • Chronic total occlusion
  • Left main coronary artery
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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