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-066
When Complete Is NOT Complete
By Amir Aziz Alkatiri, Rien Afrianti
Presenter
Rien Afrianti
Authors
Amir Aziz Alkatiri1, Rien Afrianti2
Affiliation
National Cardiovascular Center Harapan Kita, Indonesia1, Dr. Hasan Sadikin Central General Hospital, Indonesia2,
View Study Report
TCTAP C-066
CORONARY - Chronic Total Occlusion
When Complete Is NOT Complete
Amir Aziz Alkatiri1, Rien Afrianti2
National Cardiovascular Center Harapan Kita, Indonesia1, Dr. Hasan Sadikin Central General Hospital, Indonesia2,
Clinical Information
Patient initials or Identifier Number
Mr. B
Relevant Clinical History and Physical Exam
After patient underwent CABG endarterectomy on April 2020, patient experienced acute coronary syndrome 3 months after that, the coronary angiogram was done, showing graft failure in all grafts and LIMA, except SVG-OM. Patient then scheduled for stage PCI LCA and RCA. PCI to LAD and LCX was performed succesfully, 2 stent implanted in LAD and 1 stent in LCx.
Relevant Test Results Prior to Catheterization
ECG : normal sinus rythmEchocardiography : LVEF 58%, LV diastolic dysfunction gr I, Mild MR, good RV contractility
Relevant Catheterization Findings
LM : normalLAD: stent patent in proximal - mid LAD, stenosis 80% in Diagonal 1LCX : stent patent in proximal LCX, total occlusion in distal LCXRCA : subtotal occlusion in osteal - proximal RCA, CTO in mid RCA, distal RCA got collateral bridging and ipsilateral (Rentrop 2)
Graft: LIMA - LAD: total occlusionSVG - OM : patentSVG - LCX: total occlusionSVG - RCA: total occlusion
Graft: LIMA - LAD: total occlusionSVG - OM : patentSVG - LCX: total occlusionSVG - RCA: total occlusion
Interventional Management
Procedural Step
- Double puncture : right radial artery and right femoral artery - Guiding catheter : XB 3.5/6F and AL 1/7F- Anterograde wire escalation approach with microcatheter support- Buddy wire to RV branch continued with balloon anchor - Managed to cross the CTO lesion with Gaia 3- Stepwise predilatation and ivus-guided- Stenting with guide extention catheter back up, implanted 2 DES 2.75/38mm and 3.5/38mm in proximal to distal RCA- Post dilatated with 3.5 and 4.0 NC balloon with good result angiographically and acceptable MSA
LAD Benny.mov
Benny distalRCA.mov
Final.mov
LAD Benny.mov Benny distalRCA.mov Final.movCase Summary
Graft failure rarely happened,especially with LIMA. Because of the higher risk of procedural mortality with redo CABG and the similar long term outcome, PCI is the preferred revascularization strategy in patients with amenable anatomy. PCI to native artery should be the preferred approach.