01,Decwmber,2017 Complex PCI 2017 Case PresentationsⅡ
Which Is Better PCI or CABG for LMT Lesion and CTO of RCA Case?
- Decision from CT Information -
Masaaki Okutsu
Kawasaki Medical School General Medical Center
Okayama, Japan
Case
• 76y.o. Female
• Diagnosis) Effort angina and inferior OMI
• Risk factor) Hypertension, Dyslipidemia
• UCG) EF:50%, inferior:hypokinesis
• Renal function)
Cr: 0.73mg/dl, eGFR:58.4 ml/min/1.73m2, CCr:55ml/min
• SYNTAX scoreⅠ:48
• SYNTAX scoreⅡ
PCI:47.3
/ 4y mortality 26.1%
CABG:33.5
/ 4y mort 9.0%
• J-CTO score : 1
CAG
Which Is Better PCI or CABG ?
• SYNTAX scoreⅠ:48
SYNTAX scoreⅡ
PCI:47.3 / 4y mortality 26.1%
CABG:33.5 / 4y mort 9.0%
• CTO of RCA
J-CTO score: 1 (intermediate)
KCCT score: 2 (intermediate)
• Bifurcation lesion
LMT: Medina (1,1,1)
LAD prox: Medina (1,1,1)
Which Is Better PCI or CABG ?
• PCI for RCA CTO seems not to be difficult antegradely. However, retrograde access is difficult.
• LMT bifurcation has diffuse plaque with calcification from LMT to LAD but quite focal stenosis at LCX ostium caused by ulceration.
• LMT bifurcation lesion has large referential diameter.
My strategy
• Treatment strategy is PCI.
• First target is RCA CTO. LMT to LAD is second.
• If PCI is failed in RCA CTO, treatment strategy should be changed to CABG.
Summary
• CT showed detail information of CTO and LMT bifurcation.
• RCA CTO lesion could be treated by antegrade approach only.
• LMT distal bifurcation lesion was treated with single stent and without severe stenosis of LCX ostium.
• This result seems to have not so bad prognosis.
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