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-077

Intravascular Ultrasound Guided Controlled Retrograde Tracking After Failed Anterior Dissection Re-entry

By Kambis Mashayekhi, Faridun Rahimi, Najmiddin Makhkamov, Javokhir Anvarov

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Presenter

Najmiddin Makhkamov

Authors

Kambis Mashayekhi¹, Faridun Rahimi², Najmiddin Makhkamov³, Javokhir Anvarov³

Affiliation

Heartcenter Lahr, Germany¹, Doctor, Germany², Fedorovich Klinikasi LLC, Uzbekistan³,

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TCTAP C-077

CORONARY - Complex and Higher Risk Procedures for Indicated Patients (CHIP)

Intravascular Ultrasound Guided Controlled Retrograde Tracking After Failed Anterior Dissection Re-entry

Kambis Mashayekhi¹, Faridun Rahimi², Najmiddin Makhkamov³, Javokhir Anvarov³

Heartcenter Lahr, Germany¹, Doctor, Germany², Fedorovich Klinikasi LLC, Uzbekistan³,

Clinical Information

Patient initials or Identifier Number

S.H.

Relevant Clinical History and Physical Exam

Male 70 y.o.Clinical symptoms: stable angina (CCS III, NYHA II).Comorbidities: hypertension, dyslipidemia, family history.04/10/2021 patient underwent coronary angio – 2 vessel disease (RCA-CTO and significant LAD-stenosis).Recommendation for CABG, denied by the patient.03/11/2021 patient was referred to the university Heartcenter of Bad Krozingen for PCI.ECG: sinus rhythm, 88/min, left-sided type with small Q in Ill.Echo: Left ventricle with normal function. EF-50%

Relevant Test Results Prior to Catheterization

Relevant Catheterization Findings

Coronary angio: 2 vessel disease. RCA - CTO from proximal segment. LAD - significant stenosis in middle part.

Interventional Management

Procedural Step

1. Bi-radial approach – 7F (RCA - AL1; XB 3.5 - LCA). Antegrade attempt: wire escalation from XT-R to Gaia 3rd2. Multiple failures of puncturing the distal cap with wire escalation strategy (Dual lumen MC-Sasuke: Suoh3, Fielder XT/R, Gaia 3^rd, Confianza 12g).3. Superselective analysis of the epicardial ipsilateral:finally decision to change strategy based on to high risk for collateral damage.
4. Failed IVUS guided antegrade puncture with Confianza Pro 12g, due to missing visualization of the distal vessel based on the calcified plaque.5. Antegrade dissection re-entry - Gladius MG. 6. Guideliner assisted antegrade re-entry attempted with Stingray LP and Warrior 14g
with failure to re-enter.7. Switched to retrograde septal surfing with Sion Black and Caravel
with IVUS controlled retrograde wire tracking.8. IVUS with visualization of the retrograde wire in the true lumen and IVUS in the false lumen.9. Retrograde wire was placed the whole way up towards the distal cap of the CTO into the true lumen controlled by IVUS, therefor only limited stenting was necessary (1^st stent – DES 3.5x28mm).

Case Summary

1) Never underestimate ”simple” CTO lesions.2) CT prior to CTO PCI could have given important information about the plaque composition of the distal cap. 3) Failure of distal cap puncture often leads to hematoma and loose of visualization.4) ADR is an option to overcome distal cap calcification.5) In case of large antegrade dissection, retrograde bailout rescue is possible.6) IVUS controlled retrograde tracking is very useful to minimize stent-lenght, and optimized stent placement.7) Be always flexible to change the strategy for optimizing patients long term outcome.

Case

TCTAP C-077