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CASE20190923_002
| CORONARY - Chronic Total Occlusion | |
| Percutaneous Coronary Intervention Three Times for a LAD-CTO Case | |
| Qian Li1, Yaojun Zhang2 | |
| Xuzhou Third People's Hospital, China1, Thoraxcenter Erasmus Medical Center, Netherlands2, | |
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[Clinical Information]
- Patient initials or identifier number:
Y Y
-Relevant clinical history and physical exam:
Male, 76 yrs, Chief complaint: recurrent chest pain for 20 yrs, aggravated 2 weeks, Risk factors: Hypertension for 20 yrs. Lab test: LDL-C 3.60mmol/L, Cr 86¥ìmol/L; ECHO: LVDd 56mm, EF 42%. Electrocardiogram: ST segment of chest wall lead was significantly depressed.
-Relevant test results prior to catheterization:
- Relevant catheterization findings:
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[Interventional Management]
- Procedural step:
We selected the contralateral collateral circulation channel on the apical side of the heart, and the guide wire and microcatheter entered the distal LAD through the collateral, but the contralateral guide wire entered the subintima.Considering that there are large diagonal branches in the middle of LAD, the loss of diagonal branches may be caused by continuing forward.Therefore, we changed the reverse collateral circulation channel on the side of the bottom of the heart, and successfully opened the proximal occlusion with the guide wire passing technique under the guidance of IVUS. Next, the guide wire anti-kiss technique was applied to successfully open the second occlusion.
 Images.zip PCI three times for a LAD-CTO case.pptx- Case Summary:
High risk, complex PCI indicated (CHIP) patients deserve proper treatment;
Treat culprit lesion first, provides more opportunity for CTO lesion; Retrograde PCI helps to increase CTO-PCI success rate; Reverse wire escalation, reverse kissing wire are pivotal retrograde PCI technique; Secure diagonal branch, is extremely important for LAD-CTO; IVUS examination is useful for complex lesions; Successful CTO-PCI and complete revascularization improve long-term clinical outcomes for CHIP patients. |
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