CASE20210819_008
PCI on LAD Bifurcated CTO
By
1
Presenter
Afsaneh Mohammadi
Authors
1
Affiliation
, Iran1
Complex PCI - Chronic Total Occlusion
PCI on LAD Bifurcated CTO
1
, Iran1
Clinical Information
Patient initials or Identifier Number
Mrs. R T
Relevant Clinical History and Physical Exam
A 59 lady with history of HTN, Smoking presented with exertional typical chest pain from many years ago . she had done coronary angiography 7 years before admition and CABG had been recommended but she refused, now she suffered from crescendo exertional chest pain & dyspnea and was referred for coronary angiography.physical examination was unremarkable.
Relevant Test Results Prior to Catheterization
ECG was unremarkable & in echocardiography LVEF was normal without significant valvular involvement.Exercise test was positive.Lab data was within normal limits.
Relevant Catheterization Findings
Coronary angiography showed LAD CTO with significant diagonal stenosis.RCA was normal.
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TEIMOORI_ROBABE_(S1_F1-62).avi TEIMOORI_ROBABE_(S2_F1-43).avi TEIMOORI_ROBABE_(S6_F1-52).aviInterventional Management
Procedural Step
Bifemaoral approach
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Guide catheter : JR 4-6 for RCA & 3.5-7 EBU for LCA
Plan: ante / retro
Microcatheter: caravel Asahi
Wire : fielder XT , Gai1 then downgrade to XTR for LAD CTO & sion blue for diagonal
Predilation : 1-10 saphaier & 2.5-12 NC on LAD & D due to heavy calcification
Trap it for exchange
2 stent approach by mini crush
Unfortunately after diagonal stenting wire of LAD was lost and rewiring by pilot was done again that was challenging due to dissection in LAD.
2.75-15 xience stent on diagonal & 2.5-28 xience sierra stent on LAD
Kissing balloon
First & final POT by 3-8 NC balloon.
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Bidirectional injection is mandatory to clarify the lesion, caravel microcatheter was helpful for running in diffuse narrow LAD.
Upfront 2 stent bifurcation stenting was required in this patient due to large diagonal artery , even bigger than LAD artery.
Careful wire manipulation is mandatory to prevent wire loss during bifurcation stenting.