Lots of interesting abstracts and cases were submitted for TCTAP & AP VALVES 2020 Virtual. Below are accepted ones after thoroughly reviewed by our official reviewers. Don¡¯t miss the opportunity to explore your knowledge and interact with authors as well as virtual participants by sharing your opinion!
* The E-Science Station is well-optimized for PC.
We highly recommend you use a desktop computer or laptop to browse E-posters.
CASE20190822_001
| CORONARY - Chronic Total Occlusion | |
| Far Far Away | |
| Chun-Wei Lee1 | |
| Mackay Memorial Hospital, Taiwan1, | |
|
[Clinical Information]
- Patient initials or identifier number:
16461636
-Relevant clinical history and physical exam:
59 year-old male suffered from NSTEMI in 2009-01.Coronary angiography showed LM + TVD.CABG was then performed:
LIMA--> LAD-dSVG: Ao--> RCA-dSSVG: Ao--> LAD-Dx--> LCX-dHowever, during operation, the surgeon found that the LIMA to LAD flow is not good enough. He made another bypass graft(Y-graft), by using the SSVG, which is another graft from Ao- to LAD-d.  AP Cra.avi AP Cau.avi RCA.avi-Relevant test results prior to catheterization:
ECG and CXR showed no obvious abnormal result.Myocardial perfusion scan showed positive result.
  - Relevant catheterization findings:
Native vessel:LAD-CTOLCX stenosisRCA-CTO
Bypass Vessel:LIMA total occlusionRCA graft patentY graft bifurcation critical stenosis RCA Graft 2.avi LCX Graft 4.avi AP Cra.avi |
|
|
[Interventional Management]
- Procedural step:
First Target: Anterior territory (Native LAD) then Lateral (LCX & Dx)6Fr MB 1 & 6Fr BL 3.5Try AntegradeXTA--> Gaia 1st--> Gaia 3rd still cannot pass.Then consider Retrograde.We have 2 retrograde path to choose: RCA vs. Y-GraftBoth need to pass vein graftAfraid of RCA & collateral damage (the only healthy vessel)
Choose retrograde via Y-graft MC stride + SION Blue ES--> UB3Wire enter LCX further But not LM.Retrograde wire direct passTry Tip-in MethodWe finally enter guiding.IVUS confirm, then POBA and DES. 24 retro.avi 71 RetroΦ.avi 98.avi- Case Summary:
1. A post-CABG CTO intervention is always difficult2. We choose to treat the native LAD by retrograde(via Y-graft).3. Tip-in technique is very useful in retrograde PCI, especially in when retrograde MC cannot enter antegrade guide.4. We direct stent the vein graft to Dx & LCX due to native flow mainly from LM to LAD and to avoid complicated LM-bifurcation stenting.
|
|
0