CASE20210816_006
A Case of In-stent CTO of ostial RCA with Distal Dissection with IVUS Guiding
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Presenter
Rohit Mody
Authors
1
Affiliation
, India1
Complex PCI - Chronic Total Occlusion
A Case of In-stent CTO of ostial RCA with Distal Dissection with IVUS Guiding
1
, India1
Clinical Information
Patient initials or Identifier Number
173869
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%
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.