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Lots of interesting abstracts and cases were submitted for TCTAP 2024. 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-002

Contribution of Ipsilateral Collateral in pPCI

By Minh Hung Ngo

Presenter

Minh Hung Ngo

Authors

Minh Hung Ngo1

Affiliation

Choray Hospital, Vietnam1,
View Study Report
TCTAP C-002
Coronary - ACS/AMI

Contribution of Ipsilateral Collateral in pPCI

Minh Hung Ngo1

Choray Hospital, Vietnam1,

Clinical Information

Patient initials or Identifier Number

Relevant Clinical History and Physical Exam

A 85 year old gentleman presented to ED with typical angina lasting for more than 30 minutes and diagnosed as STEMI. Clinical examination showed crackle at the base of two lungs and no heart murmur. The patient was then indicated for PPCI

Relevant Test Results Prior to Catheterization

ECG: Normal sinus rhythm with ST elevation at anterior wall and Q waves at V1-V5.Trop I hs > 25000pg/mlTTE showed EF 30% with anterior wall hypokinesia

Relevant Catheterization Findings

The culprit lesion was a total occlusion of mid LAD with rentrop 2 contralateral from RCA to distal LAD.

Interventional Management

Procedural Step

The culprit lesion was a total occlusion of mid LAD. we couldn't cross the lesion with soft wire because the wire kept going to the septal branches. After many attempts without success, the wire kept going to septal branch and made a U turn to the surface of the heart. We thought that this ipsilateral might contribute to the intervention. Therefore, we used this wire to cross the ipsilateral branch and went up through the distal occlusion to proximal occluded segment. Another wire was then used to puncture the proximal occlusion directing to the landmark of the first one and kissing wire was then successful performed and the primary PCI procedure was then finished with door-to-balloon time 75 minutes. 



Case Summary

Ipsilateral collateral protects myocardium and provides information or an alternative way for wiring and puncturing the distal cap, going through the occluded segment and help to finish PCI procedures faster. Ipsilateral retrograde approach can be used not only in elective but also in primary PCI if the experienced operator realize that it is suitable.