Total Occlusion in Three Coronary Main Vessels, How Could the Patient Survive?: A Case Report
Keywords:
Coronary artery disease, Acute coronary syndrome, Chronic total occlusion,, Total occlusionAbstract
Coronary artery disease (CAD) is one of the most common diseases in developed countries and has a high morbidity and mortality. ST-elevation myocardial infarction (STEMI) accounts for approximately 30% of all acute coronary syndrome (ACS) cases. Total occlusion refers to a complete blockage of a coronary artery, this blockage significantly reduces or completely stops blood flow to the heart muscle. Chronic Total Occlusion (CTO) is defined as a 100% occlusion of a coronary artery that has been present for at least 3 months. CTO can be found in various clinical situations, such as ACS, or discovered during evaluation with imaging modalities when there is a complaint of chest pain, or when the patient undergoes angiography when undergoing valve replacement surgery, or surgery for congenital heart disease. Management of patients with CTO remains a challenge, so more detailed examination is needed to achieve the best results
Downloads
References
Sanchis-Gomar, F.; Perez-Quilis, C.; Leischik, R.; Lucia, A. Epidemiology of coronary heart disease and acute coronary syndrome. Ann. Transl. Med. 2016, 4, 256. [CrossRef] [PubMed]
Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the global burden of disease study 2017. Lancet. (2018) 392:1736–88. doi: 10.1016/S0140-6736(18)32203-7
Kolansky, D.M. Acute coronary syndromes: Morbidity, mortality, and pharmacoeconomic burden. Am. J. Manag. Care 2009, 15, S36–S41. [PubMed]
Collet JP, Thiele H, Barbato E, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021; 42: 1289–367.
Omer MA, Tyler JM, Henry TD, et al. Clinical characteristics and outcomes of STEMI patients with cardiogenic shock and cardiac arrest. JACC Cardiovasc Interv 2020; 13: 1211–19.
Balitbang Kemenkes RI. (2013). Riset Kesehatan Dasar 2013. https://pusdatin.kemkes.go.id/ resources/download/general/Hasil%20 Riskesdas%202013.pdf. p. 83–99. Accessed 5 June 2022.
Cleveland Clinic. 2021. https://my.clevelandclinic.org/health/diseases/22068-stemi-heart-attack
Hina Akbar, et al. 2024 Acute ST-Segment Elevation Myocardial Infarction (STEMI). https://www.ncbi.nlm.nih.gov/books/NBK532281/#:~:text=An%20acute%20ST%2Dsegment%20elevation,may%20also%20lead%20to%20STEMI.
Martin SS, Aday AW, Almarzooq ZI, et al. 2024 heart disease and stroke statistics: A report of US and global data from the American Heart Association. Circulation 2024;149:e347-e913.
Ismir Fahri. 2021 STEMI IN INDONESIA: Social-Economics & Demographic Challenges. Indonesian Heart Association/ Indonesian Society of Interventional Cardiology Indonesia.https://www.summitmd.com/pdf/pdf/8625_IsmirFahri.pdf
https://www.physio-pedia.com/Coronary_Artery
Robin Smithuis and Tineke Willems. 2008 Coronary anatomy and anomalies. Radiology department of the Rijnland Hospital Leiderdorp and the University Medical Centre Groningen, the Netherlands. https://radiologyassistant.nl/cardiovascular/anatomy/coronary-anatomy-and-anomalies
Normal and variant coronary arterial and venous anatomy on high-resolution CT angiography. Kini S, Bis KG, Weaver L. AJR Am J Roentgenol. 2007;188:1665–1674. doi: 10.2214/AJR.06.1295. [DOI] [PubMed] [Google Scholar]
Low coronary wall shear stress is associated with severe endothelial dysfunction in patients with nonobstructive coronary artery disease. Kumar A, Hung OY, Piccinelli M, et al. http://Epub 2018 Sep 26. JACC Cardiovasc Interv. 2018;11:2072–2080. doi: 10.1016/j.jcin.2018.07.004. [DOI] [PMC free article] [PubMed] [Google Scholar]
Plaque rupture in coronary atherosclerosis is associated with increased plaque structural stress. Costopoulos C, Huang Y, Brown AJ, et al. JACC Cardiovasc Imaging. 2017;10:1472–1483. doi: 10.1016/j.jcmg.2017.04.017. [DOI] [PMC free article] [PubMed] [Google Scholar]
Endothelial shear stress in the evolution of coronary atherosclerotic plaque and vascular remodelling: current understanding and remaining questions. Wentzel JJ, Chatzizisis YS, Gijsen FJ, Giannoglou GD, Feldman CL, Stone PH. Cardiovasc Res. 2012;96:234–243. doi: 10.1093/cvr/cvs217. [DOI] [PubMed] [Google Scholar]
Presence of ramus intermedius increases the risk of atherosclerotic plaque formation at the left main bifurcation's region: a retrospective study from CT coronary angiography in UMMC . Rosani NS, Zamin RM, Zulkafli IS, et al. Int. J. Cardiol. 2021;345:19. [Google Scholar]
Coronary computed tomography angiography study on the relationship between the ramus intermedius and atherosclerosis in the bifurcation of the left main coronary artery. Zhang DQ, Xu YF, Dong YP, Yu SJ. BMC Med Imaging. 2023;23:53. doi: 10.1186/s12880-023-01009-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
Abstract 16364: presence of ramus intermedius artery is associated with higher atherosclerotic plaque burden in the left main stem in coronary ct angiography. Pourafkari L, Kinninger A, Fazlalizadeh H, et al. https://doi.org/10.1161/circ.148.suppl_1.16364 Circulation. 2023;148:0. [Google Scholar]
Acute myocardial infarction with simultaneous thrombosis of multiple coronary arteries. Yim TH, Kim JS, Kim BC, et al. https://doi.org/10.15746/sms.15.006 Soonchunhyang Med Sci. 2015;21:24–27. [Google Scholar]
Coronary dominance patterns in the human heart investigated by corrosion casting. Abuchaim DC, Spera CA, Faraco DL, Ribas Filho JM, Malafaia O. Rev Bras Cir Cardiovasc. 2009;24:514–518. doi: 10.1590/s0102-76382009000500013. [DOI] [PubMed] [Google Scholar]
Prevalence of anatomical variants and coronary anomalies in 543 consecutive patients studied with 64-slice CT coronary angiography. Cademartiri F, La Grutta L, Malagò R, et al. Eur Radiol. 2008;18:781–791. doi: 10.1007/s00330-007-0821-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
Anatomy of the lateral, diagonal and anterosuperior arterial branches of the left ventricle of the human heart. Ortale JR, Filho JM, Paccola AMF, et al. Braz J Cardiovasc Surg. 2005;20:149–158. [Google Scholar]
Antoni, M. Louisa, et al. 2011 Distribution of culprit lesions in patients with ST-segment elevation acute myocardial infarction treated with primary percutaneous coronary intervention. Coronary Artery Disease 22(8):p 533-536, December 2011. | DOI: 10.1097/MCA.0b013e32834c7552
Charis Costopoulos, et al. 2017 Plaque Rupture in Coronary Atherosclerosis Is Associated With Increased Plaque Structural Stress. JACC Cardiovasc Imaging. 2017 Dec;10(12):1472–1483. doi: 10.1016/j.jcmg.2017.04.017
Jiannan Dai, et al. 2018 In vivo predictors of plaque erosion in patients with ST-segment elevation myocardial infarction: a clinical, angiographical, and intravascular optical coherence tomography study. European Heart Journal, Volume 39, Issue 22, 07 June 2018, Pages 2077–2085, https://doi.org/10.1093/eurheartj/ehy101
Christine Kyme. 2005 Locations of plaque rupture in coronary arteries. Nat Rev Cardiol 2, 495 (2005). https://doi.org/10.1038/ncpcardio0306
Carlotta Onnis, et al. 2024 Whys and Wherefores of Coronary Arterial Positive Remodeling. Arterioscler Thromb Vasc Biol. 2024;44:2416–2427. DOI: 10.1161/ATVBAHA.124.321504
Peregrine Green, Paul Frobisher, Steve Ramcharitar. 2016 Optimal angiographic views for invasive coronary angiography: a guide for trainees. Br J Cardiol 2016;23:110–3doi:10.5837/bjc.2016.028
Lindsey Cilia, et al. 2024 A non-interventional cardiologist’s guide to coronary chronic total occlusions. Front. Cardiovasc. Med., 06 February 2024. Sec. General Cardiovascular Medicine Volume 11 – 2024 https://doi.org/10.3389/fcvm.2024.1350549
Tasuku Hasegawa, et al. 2013 Differences in the Clinical and Angiographic Characteristics of Chronic Total Oclusion Lesions in the Three Major Coronary Arteries. Wiley Periodicals, Inc. DOI: 10.111/joic.12085
Hyon Joo Kwag. 2012 Differentiation of Acute Total Occlusion of Coronary Artery from Chronic Total Occlusion in Coronary Computed Tomography Angiography. J Korean Soc Radiol. 2012 Aug;67(2):93-99. English. Published online Aug 31, 2012.https://doi.org/10.3348/jksr.2012.67.2.93
Calum Creaney, Simon J Walsh. 2020 Antegrade Chronic Total Occlusion Strategies: A Technical Focus for 2020. https://www.icrjournal.com/articles/antegrade-chronic-total-occlusion-strategies-technical-focus-2020
Miftah Pramudyo, et al. 2022 Predictors of In-Hospital Mortality in Patients with Acute Coronary Syndrome in Hasan Sadikin Hospital, Bandung, Indonesia: A Retrospective Cohort Study. Acta Med Indones - Indones J Intern Med, Vol 54, Number 3, July 2022
Korinan Fanta, et al. 2021 Management and 30-Day Mortality of Acute Coronary Syndrome in a Resource-Limited Setting: Insight From Ethiopia. A Prospective Cohort Study. Front. Cardiovasc. Med., 17 September 2021. Sec. Coronary Artery Disease.Volume 8 - 2021 | https://doi.org/10.3389/fcvm.2021.707700
Chun-Yuan Chu, Tsung-Hsien Lin, Wen-Ter Lai. 2017 The Management and Prognostic Factors of Acute Coronary Syndrome: Evidence from the Taiwan Acute Coronary Syndrome Full Spectrum Registry. Acta Cardiol Sin. 2017 Jul;33(4):329–338. doi: 10.6515/ACS20161205A
Chistofferson RD, Lehman KG, Martin GV, Every N, Caldwell JH, Kapadia SR. Effect of chronic total coronary occlusion on treatment strategy. Am J Cardiol 2005;95:1088-1091.
Davies A, Fox K, Galassi AR, Banai S, Ylä-Herttuala S, Lüscher TF. Management of refractory angina: an update. Eur Heart J. 2021;42:269-83.
Azzalini L, Jolicoeur EM, Pighi M, Millán X, Picard F, Tadros VX, Fortier A, L’Allier PL, Ly HQ. Epidemiology, Management Strategies, and Outcomes of Patients With Chronic Total Coronary Occlusion. Am J Cardiol. 2016;118:1128-35.
Werner GS, Surber R, Ferrari M, Fritzenwanger M, Figulla HR.The functional reserve of collaterals supplying long-term chronic total coronary occlusions in patients without prior myocardial infarction. Eur Heart J. 2006;27:2406-12.
Chung CM, Nakamura S, Tanaka K, Tanigawa J, Kitano K, Akiyama T, Matoba Y, Katoh O. Effect of recanalization of chronic total occlusions on global and regional left ventricular function in patients with or without previous myocardial infarction. Catheter Cardiovasc Interv. 2003:368-74.
Nagalli S, Kikkeri NS, Nasir U, Rai Ahuja K, Ali Waheed T, Bhatia N. Trends and In-Hospital Outcomes of Patients Admitted with ST Elevation Myocardial Infarction and Chronic Total Occlusions: Insights from a National Database. Curr Probl Cardiol. 2023;48:101132.
Lemkes JS, Janssens GN, van der Hoeven NW, Jewbali LSD, Dubois EA, Meuwissen MM, Rijpstra TA, Bosker HA, Blans MJ, Bleeker GB, Baak RR, Vlachojannis GJ, Eikemans BJW, van der Harst P, van der Horst ICC, Voskuil M, van der Heijden JJ, Beishuizen A, Stoel M, Camaro C, van der Hoeven H, Henriques JP, Vlaar APJ, Vink MA, van den Bogaard B, Heestermans TACM, de Ruijter W, Delnoij TSR, Crijns HJGM, Jessurun GAJ, Oemrawsingh PV, Gosselink MTM, Plomp K, Magro M, Elbers PWG, Spoormans EM, van de Ven PM, Oudemans-van Straaten HM, van Royen N. Coronary Angiography After Cardiac Arrest Without ST Segment Elevation: One-Year Outcomes of the COACT Randomized Clinical Trial. JAMA Cardiol. 2020;5:1358-65.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
