Patient M. 54 y.o., male, suffered within 5 years from Angina with mild exertion Class 3.
Postinfarction Cardiosclerosis - Acute Miocardial Infarction 5 years ago
Unsuccessful attempts of Cx CTO recanalizations
Echocardioscopy: EF - 50%, Hypokinesia of apico-inferior, apico-lateral and apical segments
Prolonged left type Cx in-stent occlusion from ostium to the distal bifurcation with ambiguous proximal cap at the left main trifurcation and epicardial and septal collateralsJ-CTO - 4ProgressCTO - 2 1.wmv
Patient had prolonged left type ostium Cx in-stent chronic total occlusion with ambiguous proximal cap and unclear distal cap. He had also well developed epicardial collateral from Intermediate to Cx and septal collaterals. Sion blue with Corsair successfully crossed septal loop and achieved the distal cap of occlusion near bifurcation. Tip injection was performed and shown false lumen position of distal occluded stent. Both antegrade and retrograde attempts were performed and channel dilatation allowed retrograde wire to place in guiding catheter. Trapping and externalization were performed. After predilatation 3 DES from Cx to LM were implanted. POT, TAP-stenting of IMA, trifurcation-kissing, post-POT consequently were performed. distal cap.wmv tri-ball.wmv fin1.wmv
CTOs are the most difficult and unpredictable procedures in coronary interventions and operator have to be ready to deal with all contemporary coronary techniques to achieve procedural success and to show reliable long-term result.