الفهرس 
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Abstract
CTO of the coronary artery is characterized by significant atherosclerotic vessel narrowing with lumen compromise. This compromise results in either complete interruption of antegrade blood flow as assessed by coronary angiography (true total occlusions) or with minimal contrast penetration through the lesion without distal vessel opacification (functional total occlusions) for more than 3 months.
Successful revascularization of CTO has been shown to alleviate anginal symptoms, improve LV function with survival improvement.
The aim of this study was to assess the short and intermediate –term outcomes of successful revascularization of coronary CTO of LAD by PCI or CABG in Sohag University Hospital.
This study was carried out on 80 patients with symptomatic CAD attributable to CTO LAD of duration ≥ 3months.
All patients were subjected to detailed history taking, full clinical evaluation before, 6 months and12 months after revascularization (PCI or CABG) assessing the CCS angina class, NYHA class and echocardiography parameters of LV dimesions, function and changes in degree of MR. Also the patients were assessed in regard to inhospital and follow up major adverse cardiac events (MACE).
According to type of procedure, patients were classified into 2 groups (PCI and CABG). Both groups were age and sex matched with no significant difference between both groups as regard cardiovasculare risk factors.Technical success was defined as restoration of TIMI flow grade II or III & with a residual stenosis of ≤ 20%. Procedural success was defined as technical success without in hospital MACE. MACE was defined as death, MI, urgent CABG or urgent PCI.
The results of this study showed that all patients were symptomatic with no difference in CCS anginal class. Most of patients had NYHA class II &III with no significant difference between both. There were no significant difference in baseline echocardiographic data including LV ejection fraction, LV dimensions, and MR severity. All patients in the study had CTO in LAD with or without significant lesion in another coronary artery.
Results of follow up revealed significant and comparable improvement in angina class and NYHA class in both groups. Also our results showed significant and comparable improvement of LV dimensions, EF and degree of MR in both groups.
Our results revealed no significant difference in mortality, MI and stroke in both groups, but the overall MACE was more in patients revascularized by PCI than those underwent CABG due to significant higher rate of repeat revascularization in PCI group.
Results showed that the higher rate of repeat revascularization in the PCI group compared to CABG group was significantly attributed to the use of BMS than DES. When compared with CABG, our study showed that treatment of CTO with DES have comparable results as regard overall MACE and need for repeat revascularization specially with good selection of patiens with suitable angiographic criteria for attempt PCI.
Conclusion
PCI to CTO is an effective therapeutic procedure with an acceptable high success rate & low incidence of complications in patients with good selection criteria.
Revascularization of CTO has beneficial clinical outcome. It alleviates anginal symptoms, improves NYHA class. Most patients become angina free after successful revascularization of CTO.
Successful PCI to CTO improves global and segmental left ventricular systolic function. It improves ejection fraction & LV dimensions with subsequent improvement in mitral regurgitation in symptomatic patients in short and intermediate follow-up.
DES enhances angiographic patency rates, freedom from recurrent angina, and freedom from MACE. It reduces the need for repeat revascularization after PCI in CTOs compared to BMS. Treating CTO with DES is comparable with CABG in patients with favorable angiographic findings.
RECOMMENDATIONS
Good selection of patients with favorable angiographic characteristics of CTO to be treated by PCI enhance success rate and decrease the complications, need for CABG and overall MACE. The use of DES should be mandatory in all cases with PCI of CTO, the laws of health insurance and the state’s expense treatment should be changed to sponsor DES for those patients specially who have CTO.