K.S.E.

History of stable ischemic heart disease for one year. Reduced exercise tolerance and a poor quality of life within two months. Exercise stress testing is positive. Left ventricular posterior wall hypokinesia; LVEF is 60%.

Complete blood count blood test result:RBC 5,1×10¹²/L;HGB 150,0 g/L; PLTs 354,0×10⁹/L; MPV 8,1fL; PCT 0,29 %; PDW 16,6 %; WBC12,7×10⁹/LBiochemical blood test result:K 4,8 mmol/L; glucose 17,1 mmol/L; HDL cholesterol 1,7 mmol/L; total protein 78,6 g/L; totalbilirubin 7,3mmol/L; VLDL cholesterol3,7mmol/L; atherogenic coefficient 4,5; Sodium 36,000 mmol/L; 

RCA is dominant.  LAD and CXA are with uneven contour. RCA is occluded in the proximal segment, distal part of the artery is supplied by collaterals.
КАГ 1.avi

There were multiple attempts of antegrade RCA recanalization by intracoronary guide wire of various stiffness. After this, an extended dissection of the RCA was found out. During the performing contralateral visualization of the RCA distal part from the LCA it was detected that coronary guide wire wasin the pericardial cavity. The decision to perform retrograde RCA recanalization was made. Retrograde RCA recanalization via the septal branch has been successfully completed. RCA dilation was performed using balloon catheters 1.25x15 mm, 2. 5x30 mm.3 DES (3,0x38 mm, 3,5x38 mm, 4,0x24 mm) were implanted.  

The instruments availability and the ability of the team to use retrograde coronary recanalization techniques is an important condition for the cath lab. Therefore, it may be the only chance for a successful coronary intervention completion.