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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-073

Presenter

Hieu Ba Tran

Authors

Hieu Ba Tran1

Affiliation

Vietnam National Heart Institute, Vietnam1,
View Study Report
TCTAP C-073
CORONARY - Complications

The Danger at the End of CTO Intervention: How to Manage the Septal Perforation

Hieu Ba Tran1

Vietnam National Heart Institute, Vietnam1,

Clinical Information

Patient initials or Identifier Number

NTT

Relevant Clinical History and Physical Exam

65 y/o female patient Risk factor: Dyslipidemia, Hypertension, Diabetes Prior History: - Acute myocardial infarction 2017, lad stenting Admission: Angina on exertion Clinical status: BMI in normal No edema, No hepatomegaly, No tachycardiaBP under control

Relevant Test Results Prior to Catheterization

ECG: Sinus rhythm No ST _ T elevation Echo LVEF: 45% Hypokinesia in inferior wall Renal, Cardiac biomarker in normal range

Relevant Catheterization Findings

- Mid to moderate restenosis of LAD stent - Abnormal orifice of RCA - CTO in mid RCA- Collaterals via septal branches 
MOVIE-0002.mp4
MOVIE-0005.mp4
MOVIE-0006.mp4

Interventional Management

Procedural Step

- Both access: 6 Fr in radial, 7 Fr in femoral - DEB in LAD Stent - Surfing sion black via septal to distal RCA - Retrograde wire to ostium of rca with sion black and gaia - Snare to GC to RCA - Put 3 stent in RCA - Perforated brance happen when retrieval of Microcatheter,- Prevent septal hematoma so we occlude that perforation - Engage the cutting tip and part of balloon body (TPBB) to perforated septal branch to occlude - Engage the plain balloon in wire to move that part (TPBB)  to leave at the perforated septal branch - Check angio and do it one more ( TpBB 2) - Check angio again, so the procedure succeeded- Stop the procedure
MOVIE-0042.mp4

Case Summary

- CTO is always a challenging case, require many tips and tricks to overcome - Complication is a part of that, especially septal perforation during engaging devices- Cutting the tip and body balloon to occlude the perforation regard effective to prevent septal hematoma

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