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-090
Woven Right Coronary Artery With an Abnormal Origin, A Challenging Case
By Ahmed Shahin, Mohamed Ramadan, Amr Elsheikh, Ahmed Rashad, Mahmoud Khalil, Osama Shoeib
Presenter
Ahmed Shahin
Authors
Ahmed Shahin1, Mohamed Ramadan1, Amr Elsheikh1, Ahmed Rashad1, Mahmoud Khalil1, Osama Shoeib1
Affiliation
Tanta University Hospital, Egypt1,
View Study Report
TCTAP C-090
CORONARY - Complex and Higher Risk Procedures for Indicated Patients (CHIP)
Woven Right Coronary Artery With an Abnormal Origin, A Challenging Case
Ahmed Shahin1, Mohamed Ramadan1, Amr Elsheikh1, Ahmed Rashad1, Mahmoud Khalil1, Osama Shoeib1
Tanta University Hospital, Egypt1,
Clinical Information
Patient initials or Identifier Number
K. E. A.
Relevant Clinical History and Physical Exam
Female Age: 52 years Not hypertensive, Diabetic on oral hypoglycemic Dyslipidemic on Simvastatin Not cardiac before. Current medication: Aspirin, Simvastatin and Meftormin. Presenting with episodes of exertional anginal pain for 3 months.
- ECG: sinus rhythm HR 70 bpm, T wave inversion in leads V1-V6, and in leads II, III, aVF
- ECHO: picture of ischemic heart disease with SWMA in inferior and basal anterior wall with LV ejection fraction around 50%
- B/P 130/70
- HR: 80 bpm
- Normal JVP, heart and lung exam
Relevant Test Results Prior to Catheterization
- Creatinine: 0.9 mg/dl (79.5 umol/L)
- Normal cardiac markers and hemoglobin level
- Normal bleeding and coagulation profiles
Relevant Catheterization Findings
Access: Right Femoral Engaging the left main coronary with Judkin left catheter Shows a LAD lesion that was stented provisionally LCX showed no significant lesion The RCA was impossible to engage using Judkin Right catheter, also, Amplatz right catheter was tried. Finally, the RCA was engaged with a Judkin Left 3.5 guide catheter showing a woven-shaped lesion after the RV branch.
Interventional Management
Procedural Step
After multiples trials to engage the RCA, finally, the RCA was engaged with a Judkin Left 3.5 guide catheter showing a woven-shaped lesion after the RV branch Anchoring guidewire technique was used to stabilize the system with a BMW guidewire used to wire the RV branch, then another guidewire Fielder XT wire was used to wire the RCA. PTCA to the RCA lesion with a semi compliant balloon 2.5 X 12 mm inflated at optimum atm then stenting of the RCA lesion with a DES 2.75 X 18 mm with good angiographic results for both LAD and RCA.
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Series_045_Left Coronary 15 fps.wmv
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Series_051_Left Coronary 15 fps.wmv
Series_038_Left Coronary 15 fps.wmv Series_045_Left Coronary 15 fps.wmv Series_047_Left Coronary 15 fps.wmv Series_051_Left Coronary 15 fps.wmvCase Summary
If the RCA couldn’t be found on the right coronary cusp, search for it on the left coronary cusp. Left coronary catheter as Judkin Left and Extra Back-up catheter may be used to engage the RCA in such cases. The woven coronary artery anomaly is a rare congenital anomaly in which a coronary artery is divided into thin channels that merge again into the distal lumen. It is still controversial wither to treat or not. Woven-shaped or (Honeycomb) coronaries may be misleading or missed and require special attention. This is the first reported woven RCA case with abnormal origin.