Lots of interesting abstracts and cases were submitted for TCTAP 2022. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!
TCTAP C-117
Wire Perforation in Posterior Lateral Artery Treated with Coil During Right Coronary Artery Chronic Total Occlusion Intervention.
By Mohd Al-Baqlish Mohd Firdaus, Jayakhanthan Kolanthaivelu, Kumara Gurupparan Ganesan, Shaiful Azmi Yahaya
Presenter
Mohd Al-Baqlish Mohd Firdaus
Authors
Mohd Al-Baqlish Mohd Firdaus1, Jayakhanthan Kolanthaivelu2, Kumara Gurupparan Ganesan3, Shaiful Azmi Yahaya3
Affiliation
Kulliyyah of Medicine, International Islamic University Malaysia, Malaysia1, Cardiovascular Sentral Kuala Lumpur, Malaysia2, National Heart Institute, Malaysia3,
View Study Report
TCTAP C-117
CORONARY - Complications
Wire Perforation in Posterior Lateral Artery Treated with Coil During Right Coronary Artery Chronic Total Occlusion Intervention.
Mohd Al-Baqlish Mohd Firdaus1, Jayakhanthan Kolanthaivelu2, Kumara Gurupparan Ganesan3, Shaiful Azmi Yahaya3
Kulliyyah of Medicine, International Islamic University Malaysia, Malaysia1, Cardiovascular Sentral Kuala Lumpur, Malaysia2, National Heart Institute, Malaysia3,
Clinical Information
Patient initials or Identifier Number
432955
Relevant Clinical History and Physical Exam
67-year-old lady with underlying Type II Diabetes Mellitus and hypertension. She was initially presented to other hospital with heart failure symptoms for two weeks. On examination there were bilateral pedal odema, bibasal lung crepitation and no cardiac murmur was heard. She underwent diagnostic coronary angiogram and was referred to our centre for complex coronary intervention.
Relevant Test Results Prior to Catheterization
Hemoglobin : 13.7 g/dL Platelet : 275 x 10^9/L Total white Count: 8.3 x 10^9/L
Cardiac MRI shows viable of 15 out of 17 myocardial segments.
Cardiac MRI shows viable of 15 out of 17 myocardial segments.
Relevant Catheterization Findings
Left main coronary artery shows mild distal stenosis. The Left Anterior Descending artery has moderate disease at the mid-segment. The Left circumflex artery is non-dominant with mild disease. The Right Coronary artery shows mid-segment chronic total occlusion with collateral from the left system.
Interventional Management
Procedural Step
We planned for complex PCI to the mid-RCA CTO. Bilateral puncture from left radial (6fr) and right femoral (7Fr) was secured. We used SAL 7Fr guide to the RCA and Optitoque 5Fr diagnostic catheter to left system for contralateral injection. Antegrade wire escalation technique using Fielder XT and Gaya second on Caravel Microcatheter was used to cross the CTO. Subsequently, we managed to cross the CTO with Gaya second guidewire. However, we were unable to exchange to the softer wire as the caravel was unable to pass beyond the lesion. We subsequently balloon the CTO segment by using a compliance balloon 1.0mm x 5mm and a Non-compliance balloon 2.0mm x 15. Unfortunately upon contrast injection, we noticed there were multiple distal wire perforation in from the Gaya Second. We attempted to seal the perforation with a Covered stent, prolonged balloon inflation but failed. We finally decided to seal the perforation with coiling. We subsequently stented the vessel with three drug-eluting stents. Repeated echo post-procedure no pericardial effusion.
perforation 1.mpg
sealed.mpg
perforation 1.mpg sealed.mpgCase Summary
Chronic total occlusion intervention is a complex procedure. Wire perforation is a common complication of CTO intervention and every interventional cardiologist should able to manage the complication. In this case, we depict almost all the measures to handle distal wire perforation.