Lots of interesting abstracts and cases were submitted for TCTAP 2025. 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-068
Retro With a Twist - A Case of Wire Entrapment and Stent Accordion Post Retrograde Reverse Cart PCI
By Kazi Majidur Rahaman, Rosli Mohd Ali, Boon Cong Beh, Hamat Che Hassan, Asyiq Raffali, Noor Diyana Binti Mohamad Farouk, Shawal Mohamad
Presenter
Kazi Majidur Rahaman
Authors
Kazi Majidur Rahaman1, Rosli Mohd Ali2, Boon Cong Beh1, Hamat Che Hassan1, Asyiq Raffali1, Noor Diyana Binti Mohamad Farouk1, Shawal Mohamad1
Affiliation
Hospital Canselor Tuanku Muhriz UKM, Malaysia1, Cardiac Vascular Sentral Kuala Lumpur, Malaysia2,
View Study Report
TCTAP C-068
Coronary - Complex PCI - CTO
Retro With a Twist - A Case of Wire Entrapment and Stent Accordion Post Retrograde Reverse Cart PCI
Kazi Majidur Rahaman1, Rosli Mohd Ali2, Boon Cong Beh1, Hamat Che Hassan1, Asyiq Raffali1, Noor Diyana Binti Mohamad Farouk1, Shawal Mohamad1
Hospital Canselor Tuanku Muhriz UKM, Malaysia1, Cardiac Vascular Sentral Kuala Lumpur, Malaysia2,
Clinical Information
Patient initials or Identifier Number
Relevant Clinical History and Physical Exam
A 59-years-old gentleman with background medical history of diabetes mellitus, hypertension, coronary artery disease and heart failure with reduced ejection fraction (HFrEF) admitted with chest pain. Coronary angiogram showed severe LAD stenosis with CTO of proximal RCA. LAD stenosis was treated with drug eluting stent (DES) as index procedure. Current case is an elective stage PCI to RCA and CTO opening as planned during index procedure.
Relevant Test Results Prior to Catheterization
Chest Radiograph (CXR) was normal. Echocardiography showed reduced LV function with EF 38% by Biplane method. Global hypokinetic wall motion and dilated chamber size. Routine blood test showed Stage CKD Stage III A,
Relevant Catheterization Findings
LMS: Mild disease
Interventional Management
Procedural Step
Dual vascular access (7Fr AL 1.0 and 6Fr EBU 3.5) .Workhorse (sion) guidewire and Turnpike LP microcatheter were used to cross the septal branch (Retrograde approach). Predilated the collateral with SC 1.0 x 15 mm balloon. Failed to advance the microcatheter beyond distal RCA with multiple CTO wire. A balloon dilation at proximal CTO area (antegrade wire) and then a Conquest Pro guidewire (retrograde) negotiated through subintimal space, the to then the true lumen after proximal CTO Cap and further into the AL 1.0 guide catheter (Reverse CART). Sequential Predilated with SC 2.0x15 mm, SC 3.0x15 mm balloon and treated with Two 3.5x48 mm stent overlapping each other using high pressure lumen size and location guidewire were confirmed by IVUS before stenting. Sion blue guidewire place at SA nodal branch was stuck due to wire looping at proximal stent. The wire removed by microcatheter with balloon inflation at the stent technique but, this process deformed the proximal part of stent. Managed with 4.0 x12 mm stent overlapping with previous deformed stent extending up to ostio-proximal RCA. Post dilation final IVUS run showed good stent apposition and TIMI III flow
Stenting Ostial RCA after removal jailed wire.jpg
Stenting Ostial RCA after removal jailed wire.jpgCase Summary
Reverse CART (Controlled Antegrade and Retrograde Tracking) is a complex procedure in CTO interventions. Constant operator’s concentration throughout the procedure are very important to reduce any sorts of complications. Immediate recognising of any complication and troubleshooting is mandatory fora good final outcome. Guide wire entrapment under stent struts is very common. The usage of microcatheter with balloon support technique to extract a trapped