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Lots of interesting abstracts and cases were submitted for TCTAP 2023. 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-052

A Nightmare of Main Branch Ostium In-Stent Total Occlusion Intervnetion and Plaque Shift to Left Main Lesion: A Dilemma of Rescue Order

By Meitzu Wang, Wei-Chun Huang, Cheng-Chung Hung, Chin-Chang Cheng

Presenter

Meitzu Wang

Authors

Meitzu Wang1, Wei-Chun Huang1, Cheng-Chung Hung1, Chin-Chang Cheng1

Affiliation

Kaohsiung Veterans General Hospital, Taiwan1,
View Study Report
TCTAP C-052
CORONARY - Bifurcation/Left Main Diseases and Intervention

A Nightmare of Main Branch Ostium In-Stent Total Occlusion Intervnetion and Plaque Shift to Left Main Lesion: A Dilemma of Rescue Order

Meitzu Wang1, Wei-Chun Huang1, Cheng-Chung Hung1, Chin-Chang Cheng1

Kaohsiung Veterans General Hospital, Taiwan1,

Clinical Information

Patient initials or Identifier Number

Yo U C

Relevant Clinical History and Physical Exam

The 60-year-old male had coronary artery disease and underwent coronary stenting. He had angina in Canadian Cardiovascular Society angina grade 2. There were previous coronary stents deployed in segment 1, segement 6-7 and  segement 11 from ostium.

Relevant Test Results Prior to Catheterization

¡ØMyocardial perfusion scan: reversible defect in apex, anterior wall, anteroseptal wall (20-30% decrease); partial reversible defect in inferolateral wall (60-70% decrease to 40-50% decrease).  ¡ØEstimated left ventricular ejectional fraction 56%

Relevant Catheterization Findings

¡ØLCx: -O:near total occlusion -P to -D:total occlusion -M:total occlusion 


Interventional Management

Procedural Step




The patient unerwent percutanoues coronary intervention for in-stent ostium total occlusion lesion of left circumflex (LCx). However, during wiring attempin  LCx, there was no reflow phenomenon of LCx and then plaque shifted to left main(LM). Patients complained of chest pain,  and non-sustained VT attacked with associated hypotension. Vasoactive agent was prescribed, and after hemodynamic stabilzed, LM balloon dilation was done immediately.  However, there was critical stenosis and failed to recanalized LM vessel. One drug-eluting stent (DES) with 3.0mm indiameter and 38mm in length was deployed in LM segment 5. LCx intervention was done under micricatheter support and Gaia Third 0.014" 190cm Guidewirepassed the chronic total occlusion cap. Balloon inflation and one DES stenting in LCx segment 11-13 with Culotte two stent technique were done. Moreover, kissing balloon technique abd POT were done after stenting. Final result was chescked by IVUS, and the result was optimal.

Case Summary

This is a LM bifurcation lesion, and intervention of LCx ostium complicated with plaque LM shift. The dilemma was that once LM was stented, the intervention to LCx CTO was more difficult. However, stable hemodynamic should be put on the first place. Intra-coronary image evaluation for optimal result was also important in complex PCI.