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-055
Double the Trouble - A Case of Double CTO With Poor Vascular Access
By Chi Kit Yu
Presenter
Chi Kit Yu
Authors
Chi Kit Yu1
Affiliation
Tuen Mun Hospital, Hong Kong, China1,
View Study Report
TCTAP C-055
CORONARY - Chronic Total Occlusion
Double the Trouble - A Case of Double CTO With Poor Vascular Access
Chi Kit Yu1
Tuen Mun Hospital, Hong Kong, China1,
Clinical Information
Patient initials or Identifier Number
LCL
Relevant Clinical History and Physical Exam
65 year old gentlemen who is a chronic smoker. The patient has a past medical history of IHD, old CVA and bilateral iliac occlusion. CT angiogram of lower limb showed total occlusion of right internal iliac artery, entire right SFA. The left common, internal, external iliac arteries and SFA also noted total occlusion.
Patient was initially admitted in 5/2021 for on and off chest pain for 5 year, complained of increasing chest pain for 1 month. PE HSD, PSM at apex, JVP not elevated.
Patient was initially admitted in 5/2021 for on and off chest pain for 5 year, complained of increasing chest pain for 1 month. PE HSD, PSM at apex, JVP not elevated.
Relevant Test Results Prior to Catheterization
Bld CBC : Plt 121, Hb WCC N HbA1c 8.5 FG 6.0 LDL 1.5LRFT grossly normal
ECG : SR with mild STD in V4-6
Echo: Dilated LA, Normal LVLVEF 46% with hypokinesia over apical septal and inferior wallMod MR /TR, no pericardial effusion or thrombus
ECG : SR with mild STD in V4-6
Echo: Dilated LA, Normal LVLVEF 46% with hypokinesia over apical septal and inferior wallMod MR /TR, no pericardial effusion or thrombus
Relevant Catheterization Findings
Coro finding 23/4/2021 with RFA access (puncture above bifurcation) Left main : 50% stenosis LAD: mLAD total occlusion after D1, large retrograde from RCA LCX: mLCx diffuse disease ~ 50% stenosis RCA: long diffuse disease, dRCA total occlusion with retrograde from left system
Interventional Management
Procedural Step
PCI to RCA CTO with RFA (puncture above bifurcation)RCA CTO segment crossed with Fielder XT-RLesion predilate with Sapphire 1.0/15 & 2.0/15Xience Sierra 2.5/48 at dRCA, 3.25/33 at p-mRCA and 3.5/33 at o-mRCA PSHP with NC Trek 2.75/15 and 3.5/15 up to 20 atm
PCI to LCx & LAD CTO with RFA and Right brachial approach
PCI to LCxNS Runthrough to dLAD and Fielder FC to dLCx Predilate LCx with Raiden 2.5/15Orsiro 2.5/40 at p-dLCx and 3.0/9 at pLCxPSHP with NC Sapphire 3.0/15 at 12-18 atm
PCI to LAD CTO GAIA3 unable to wire through CTO body via anterograde approach Sion was used to wire to CTO body with retrograde approach, punctured into CTO body by Fielder XT-ACorsair Pro XS and microcatheter was able to pass up to LAD but cannot advance further into GC Dilatation of LM + LAD with Ryurei 2.0/15 at 12 atm, still unable to advance Finally switch to Turnpike LP and successfully advanced into LM via retrograde approach XT-A changed to RG3 with externalization of wirePredilatation with p-mLAD with Ryurei 2.0/15 and 2.5/15 at 12-20 atmIVUS was performed Orsiro 2.25/40 at dLAD, Orsiro 2.5/40 at p-mLAD, Orsiro 3.0/22 at pLAD and Orsiro 3.5/26 at LM with overlapping POT at LM with Accuforce 4.0/6 at 16 - 22 atm PSHP to m-dLAD with Raiden 2.5/15 at 12 -20 atm and NC Sapphire 3.0/15 at 20 - 26 at p-mLADFinal IVUS showed good expansion of stent and well apposed stent
Coro finding.avi
PCI to RCA.avi
PCI to LCx & LAD CTO with RFA and Right brachial approach
PCI to LCxNS Runthrough to dLAD and Fielder FC to dLCx Predilate LCx with Raiden 2.5/15Orsiro 2.5/40 at p-dLCx and 3.0/9 at pLCxPSHP with NC Sapphire 3.0/15 at 12-18 atm
PCI to LAD CTO GAIA3 unable to wire through CTO body via anterograde approach Sion was used to wire to CTO body with retrograde approach, punctured into CTO body by Fielder XT-ACorsair Pro XS and microcatheter was able to pass up to LAD but cannot advance further into GC Dilatation of LM + LAD with Ryurei 2.0/15 at 12 atm, still unable to advance Finally switch to Turnpike LP and successfully advanced into LM via retrograde approach XT-A changed to RG3 with externalization of wirePredilatation with p-mLAD with Ryurei 2.0/15 and 2.5/15 at 12-20 atmIVUS was performed Orsiro 2.25/40 at dLAD, Orsiro 2.5/40 at p-mLAD, Orsiro 3.0/22 at pLAD and Orsiro 3.5/26 at LM with overlapping POT at LM with Accuforce 4.0/6 at 16 - 22 atm PSHP to m-dLAD with Raiden 2.5/15 at 12 -20 atm and NC Sapphire 3.0/15 at 20 - 26 at p-mLADFinal IVUS showed good expansion of stent and well apposed stent
Coro finding.avi PCI to RCA.aviCase Summary
This is a case of double CTO with poor vascular access especially right radial artery and left femoral artery due to peripheral vascular disease.
Apart from the vascular access, the main challenges are the difficulty in wiring the CTO body via anterograde approach and difficulty in advancing the Corsair Pro and microcatheter from CTO to the guiding catheter through the retrograde approach.
We successfully managed to use Turnpike and advance the XT-A to LM
Apart from the vascular access, the main challenges are the difficulty in wiring the CTO body via anterograde approach and difficulty in advancing the Corsair Pro and microcatheter from CTO to the guiding catheter through the retrograde approach.
We successfully managed to use Turnpike and advance the XT-A to LM