E-Science Station

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.

CASE20191019_003
CORONARY - Chronic Total Occlusion
Successful Bail-Out from Perforation in Long RCA-CTO
Takuma Tsuda1
Nagoya Ekisaikai Hospital, Japan1,
[Clinical Information]
- Patient initials or identifier number:
N.T.
-Relevant clinical history and physical exam:
Age:55y Targetlesion: proximal RCA CTO CoronaryRisk Factor: Dyslipidemia Historyof Present illuness: May/2016¡¡ emPCIto #6 due to ant-AMI(#6 100%¡æXienceAlpine4.0/18). Apr/2018     PCI to #8(DCB)  RCA#1 CTO was followed by OMT. 
-Relevant test results prior to catheterization:
ECGshowed abnormal Q wave in ¥±,¥²,aVF and poor R wave in V3-5 Laboratory finding showed normal renal function; (Cre/ eGFR: 1.07/ 57.0)  EF: 43%, ant/inf hypokinesis
CT showed long RCA-CTO with a few calcification 
MPI showed positive viability of inferior wall


- Relevant catheterization findings:
 May/2016¡¡ emPCIto #6 due to ant-AMI(#6 100%¡æXienceAlpine4.0/18). Apr/2018     PCI to #8(DCB) RCA CTO length was estimated about 100mm. Distal target was #4-PD/#4-PL bifurcation which has good collateral from septal branch.
 J-CTO score: 2 (CTO length/ tortuosity)  
CAG2.mov
CAG3.mov
CAG4.mov
[Interventional Management]
- Procedural step:
1.     1st retro 2.  retrograde wiring¡¡a) UB3¡æGradius:unpass   b) Sasuke+UB3¡æGradius(¡æGradiusMG):unpass   c) balloon screening+UB3¡æGradius¡æ(¡æGradiusMG):unpass 3. antegrade wiring   a) Corsair+MN3:perforation 4. 2nd retro(AC channel)   a) Caravel-tip injection: perforation   b) Suoh03: channel pass   c) UB3¡æGradius(¡æGradiusMG): pass
5. antegrade wiring   a) Gradius¡æUB3ªÇantepreparation   b) small balloon unpass 6. retro knuckle wire   a) Gradius  7. antegrade wiring   a) AWE:GN3   b) rCART   c) externalize(1st) 8. IVUS   a) IVUS:vessel perforation 9. IVUS guided wiring   a) retro-rewiring with IVUS guidance     b) externalize(2nd)
10. POBA/stenting(#2:perforation site) 11. channel check 12. POBA/stenting(#1-#4-P) 13. final angiography
4.mov
final.mov
- Case Summary:
CTO sometimes has risk of perforation. I performed atypical but representative and educational methods for bail-out of perforation under imaging modality. However we also know much more options for overcoming this kind of situations. Here I will show the importance of the way to use imaging modality even in CTO after externalization. 
like off