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Lots of interesting abstracts and cases were submitted for TCTAP 2021 Virtual. Below are accepted ones after thoroughly reviewed by our official reviewers. Don’t miss the opportunity to explore your knowledge and interact with authors as well as virtual participants by sharing your opinion!

TCTAP C-062 . Presentation

Presenter

Ramachandran Sathappan

Authors

Ramachandran Sathappan1, Tze Ming Chan1, Yew Fung Kwan1, Benjamin Tao Xiung Lim1, Jian-Chen Lim1, Hameeth Shah Abdul Wahid1, Mohd Ruslan Mustapa1, Gurpreet Pal Singh Jugindar Singh1, Hazleena Mohamed Hasnan1, Nor Hanim Mohd Amin1

Affiliation

Hospital Raja Permaisuri Bainun, Malaysia1,
View Study Report
TCTAP C-062
CORONARY - Complications

Iatrogenic Retrograde Coronary Aortic Dissection During Coronary Intervention: Rare But Life-threatening

Ramachandran Sathappan1, Tze Ming Chan1, Yew Fung Kwan1, Benjamin Tao Xiung Lim1, Jian-Chen Lim1, Hameeth Shah Abdul Wahid1, Mohd Ruslan Mustapa1, Gurpreet Pal Singh Jugindar Singh1, Hazleena Mohamed Hasnan1, Nor Hanim Mohd Amin1

Hospital Raja Permaisuri Bainun, Malaysia1,

Clinical Information

Patient initials or Identifier Number

HRPB 524763

Relevant Clinical History and Physical Exam

59-year-old Asian man with underlying hypertension, type 2 diabetes mellitus and Ischemic heart disease. He had a history of Non ST Elevation Myocardial infarction on February 2020. Cardiac catheterization showed 90% stenosis of distal LCx and chronic total occlusion of proximal LAD with good collaterals from RCA. The culprit distal LCx lesion was treated with a drug coated balloon. In view of still symptomatic, he was electively planned for proximal LAD CTO intervention.

Relevant Test Results Prior to Catheterization

Echocardiogram showed ejection fraction of 35% with anteroseptal hypokinesis.

Relevant Catheterization Findings

Catheterization with dual injection was done using Bi- radial approach (right radiac and left distal radial/snuffbox access) to study the CTO lesion.  LM was short and smooth, ostial LAD was subtotal followed by proximal CTO with good collaterals from the RCA, distal LCx which was previously treated with a DCB showed 90% stenosis. Proximal LAD CTO segment had a clear tapered proximal cap with the lesion length of <20mm. J-CTO score was 0. RCA was dominant with minor irregularities.
Catheterization findings.mp4

Interventional Management

Procedural Step

Fielder XT with Finecross wired into LAD but failed crossing. Escalated to Gaia third, crossed proximal CTO using wire-based ADR. Predilated mid to proximal LAD with NC balloon 2.0 x 15 mm @ 16 ATM followed by ostial LAD – LM with NC balloon 3.0 x 15 mm @16 ATM. EBU 3.5 guide catheter was deeply engaged hitting the carina caused a retrograde coronary aortic dissection extending less than 40mm from the LM ostium (Dunning class II) and extending antegrade to the mid LAD and distal LCx. Runthrough wired into LCx, predilated distal LCx with NC balloon 2.0 x 15 mm @16 ATM. Stented mid-distal LCx with Biomime (DES) 2.5x 48 mm @ 8 ATM followed by postdilatation with stent balloon 2.5 x 48 mm @ 12 ATM. Initial dissection over the proximal LCx sealed after stent deployment. Opted for a provisional approach. Stented prox-mid LAD with XIENCE(DES) 3.0 x 28 mm @ 10 ATM and postdilated with stent balloon 3.0 x 28 mm @ 16 ATM. LM-prox LAD was stented with Cre8(DES) 3.5 x 46 mm @ 15 ATM overlapped with the latter stent. We postdilated the overlap and proximal LAD segment with NC balloon 3.0 x 15 mm @28 ATM. POT done with NC balloon 4.0 x 15mm @26 ATM. Subsequent angiography showed dissection over the LCx worsening with TIMI 2 flow. Converted to a T-stenting as bailout. Runthrough rewired into the LCx, predilated LCx with NC balloon 2.0 mm x 15 mm @ 16 ATM. Stented prox-mid LCx with Cre8(DES) 2.75 x 20 mm @ 12 ATM (overlapped) and postdilated with stent balloon 2.75 x 20 mm @ 16 ATM.
Procedure steps.mp4

Case Summary

Iatrogenic retrograde coronary aortic dissection is a rare and potentially catastrophic complication mostly originates from catheter-induced trauma, wire induced trauma or balloon inflation, especially to the LMCA. Surgery is the choice of treatment, but in these retrograde dissections ostial stenting is an alternative. T-stenting can be done during emergencies as access to the main branch is maintained throughout the procedure. Steps are fewer which ensures expeditious coverage of both vessels followed by the kissing and proximal optimization. It also allows operators to start with a provisional strategy and convert to T-stenting should the need arise.

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TCTAP 2021 Virtual Apr 12, 2021
Thanks for sharing your report. It’s very helpful for us.