Complex LCx CTO Bifurcation Intervention

50-year-old male with extensive CAD presented with progressive CCS Class II angina and high risk SPECT MPI for multivessel ischemia as preop for renal transplantation. A cardiac cath five month prior to the procedure revealed three-vessel coronary artery disease: 95% LCx bifurcation with CTO ISR of OM1 (Medina 1,1,1), positive FFR and 60% mid LAD/D2 bifurcation (Medina 0,1,1), CTO ISR of mid RCA with LVEF = 55% and SYNTAX Score of 39. In view of multiple DES CTO ISR and CAD progression, patient was recommended to undergo CABG pre-renal transplantation. After Heart Team discussion, patient declined CABG and was placed on maximal medical therapy. Patient continued to be symptomatic despite maximal tolerated MT and underwent a high-risk intervention of LCx/OM1 bifurcation with a staged RCA/LAD intervention one month later. The case describes the complex LCx CTO bifurcation Intervention.

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All Authors: Samin K. Sharma, MD, MSCAI; Annapoorna S. Kini, MD; and Sameer Mehta, MD, MBA.

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