A Case of In-stent CTO of ostial RCA with Distal Dissection with IVUS Guiding

By Rohit Mody
like off


Rohit Mody


Rohit Mody


Complex PCI - Chronic Total Occlusion

A Case of In-stent CTO of ostial RCA with Distal Dissection with IVUS Guiding

Rohit Mody

Clinical Information

Patient initials or Identifier Number


Relevant Clinical History and Physical Exam

Patient Details-
1. 63 years old Female2. Known case Diabetes3. Known case of Hypertension4. Known case of Dyslipidemia5. History of AOE 36. DOE 37. ECG normal8. Vitals- Stable9. LV function normal EF 50%

Relevant Test Results Prior to Catheterization

LV Function Normal EF 58%

Relevant Catheterization Findings

Angiography shows normal LAD, LCX & RCA 100% CTO

Interventional Management

Procedural Step

Initially Pilot 150 was tried to cross with Balloon Support, but didn’t crossed as went to side branch, Then Conquest pro taken tried to cross wire after anchoring the wire inside branch distally unable to cross confirmed the wire is in true lumen & then balloon dilated proximally the opened artery shows distal dissection with great difficulty crossed through the dissection balloon dilated distally balloon dilated sequentially distal to proximally distal stent deployed,4 X 8 mm deployed at ostium.

Case Summary

In cases of dissection due to wire distally or preexisting spontaneous dissection we can diagnose by IVUS imaging and the desired result can be obtained after entering the true lumen with a stiffer wire and the procedure can be completed by reentering on antegrade approach.