PCI in the sole remaining conduit

Associate Editor-In-Chief: Vijayalakshmi Kunadian MBBS MD MRCP [mailto:vkunadian@perfuse.org]

PCI in the patient with sole remaining conduit
Sole remaining conduit (SRC) refers to the only remaining artery (native artery or bypass graft) with occlusion of the native and bypass supplies to the remaining two coronary arteries. There are insufficient data on percutaneous coronary intervention to a sole remaining conduit.

When patients with SRC present with severe anginal symptoms, there are three options to deal with these patients. First, perform PCI through and to the SRC. Second, to perform PCI to one or more chronic total occlusions and finally, to optimize patients with medical therapy. Other adjunct devices such as intra-aortic balloon pump may be beneficial in this setting 1. Tavano et al studied 16 patients who underwent percutaneous coronary intervention in their sole remaining vessel 2. All patients were symptomatic with unstable angina or minimal effort angina refractory to maximal medical therapy. In-hospital, one-month and 6-month major adverse cardiac events (defined as the composite of death, myocardial infarction, and target vessel revascularization) and angina status according to the Canadian Cardiovascular Society (CCS) score were assessed. During hospital stay one patient died 10 hours after the procedure secondary to acute pulmonary edema, urgent coronary angiography showed a patent target vessel. At one month 75% of patients were asymptomatic, the other 3 patients experienced symptom improvement from CCS III to CCS I. After 6 months, a second patient died after an out-of-hospital cardiac arrest that occurred 4 months after the procedure. At one year, there were no additional deaths, one patient developed non-Q-wave myocardial infarction and one patient underwent repeat PCI of the target vessel.

Conclusion
There is limited data on PCI to the sole remaining conduit. Small retrospective analysis support PCI as a treatment strategy for highly symptomatic and difficult-to-treat patient cohort.