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CASE20210819_009

PCI and Stenting in a Long Segment CTO (ISR) in a Dominant RCA, Using the Antegrade Technique

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Presenter

Harinder K. Bali

Authors

1, 1

Affiliation

, India1
Complex PCI - Chronic Total Occlusion

PCI and Stenting in a Long Segment CTO (ISR) in a Dominant RCA, Using the Antegrade Technique

1, 1

, India1

Clinical Information

Patient initials or Identifier Number

MSJ

Relevant Clinical History and Physical Exam

61 years old male, presented with complaints of exertional dyspnoea and angina. Patient was a known case of CAD, with history of inferior wall MI in 1996. He underwent PTCA to RCA with BMS at that time. This was followed by PTCA and stent to RCA in 1999, 2000 with BMS, PTCA and stent to RCA with DES in 2010, DEB to RCA in 2013. 

Relevant Test Results Prior to Catheterization

Relevant Catheterization Findings

Patient underwent CAG for his symptoms, which revealed a dominant RCA with mid segment CTO with 100% ISR., with retrograde filling of the PDA and PLV. PTCA and stenting to RCA was planned.


Interventional Management

Procedural Step

Successful PTCA and stenting for chronic total occlusion in dominant RCA ISR done using the antegrade technique. Route: right radial arteryGuiding catheter: 6f SCR 3.5Guidewires: Gaia second, Fielder XT, BMWAdditional hardware used: Telescope 6F, Asahi Caravel (micro catheter)Pre stent dilatation done with 1.25x10mm, 1.5x12mm, 2.0x12mm, 2.5x15mmXIENCE XPEDITION stents 3.0x48mm, 3.ox48mm and 2.5x23mm deployed in proximal RCA to  Post stent dilatation done with 2.5x15mm, 3.0x12mm, 3.0x15mm NC balloons










Case Summary

Antegrade technique is useful for short segment CTO’s. However we successfully performed PCI and stenting in a long segment CTO where retrograde wiring was not possible, using the antegrade wiring technique.