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-076
Impella-Assisted Complex CTO and Bifurcation PCI
By Ivan Man Ho Wong
Presenter
Ivan Man Ho Wong
Authors
Ivan Man Ho Wong1
Affiliation
Queen Elizabeth Hospital, Hong Kong, China1,
View Study Report
TCTAP C-076
CORONARY - Complex and Higher Risk Procedures for Indicated Patients (CHIP)
Impella-Assisted Complex CTO and Bifurcation PCI
Ivan Man Ho Wong1
Queen Elizabeth Hospital, Hong Kong, China1,
Clinical Information
Patient initials or Identifier Number
S.Y.
Relevant Clinical History and Physical Exam
The patient is a 76-year-old lady with history of diabetes mellitus and hypertension. She was admitted to our hospital for non-ST-segment elevation myocardial infarction (NSTEMI). Electrocardiogram showed ST depression in anterior leads.
Relevant Test Results Prior to Catheterization
Relevant Catheterization Findings
Coronary angiogram showed chronic total occlusion (CTO) of right coronary artery and left circumflex artery; critical stenosis of proximal left anterior descending artery. The case was referred to cardiothoracic surgeon in view of triple vessel disease. However, surgery was turned down in view of comorbities of the patient. Therefore, Impella-assisted percutaneous coronary intervention (PCI) to the left coronary artery was planned.
baseline LAD.mp4
baseline LCX.mp4
baseline RCA.mp4
baseline LAD.mp4 baseline LCX.mp4 baseline RCA.mp4Interventional Management
Procedural Step
Impella-CP was first inserted through right femoral artery. Next, a 7Fr sheath was inserted through the same Impella sheath for PCI. EBU 3.5 guiding catheter was engaged to left main coronary artery ostium. LCX CTO lesion was successfully crossed with parallel wire technique. p-mLCX was then predilated and stented with drug-eluting stent (DES). Then, mLAD lesion was predilated and stented with DES with modified jailed balloon technique at septal channel in order to preserve septal collateral for future interventional options for RCA CTO. Double kissing (DK) crush technique was used for left main bifurcation lesion. o-pLCX was stented with DES and then crushed. LCX was then rewired and kissing balloon inflated with LAD. Next, LMN-pLAD was stented with DES with modified jailed balloon technique at diagonal branch. DK crush was then completed with second kissing balloon inflation and proximal optimization technique.
LCX PCI.mp4
PCI LAD.mp4
finishing.mp4
LCX PCI.mp4 PCI LAD.mp4 finishing.mp4Case Summary
In high-risk complex PCI procedures, mechanical circulatory support with Impella-CP can improve procedural safety. Single access PCI within Impella sheath can also minimize vascular complications. Usage of modified jailed balloon technique can significantly improve side-branch patency. Double kissing crush technique can achieve optimal outcome in left main bifurcation setting.