TCTAP & AP VALVES 2020 Virtual

Catheterization thought Left snuffbox artery (d-RA) and RT radial artery – guiding catheters (7 FR XB 3.5 for LCA and 7 FR AL 1 for RCA).Ø Plan:• PCI to LM • PCI to RCA CTO

Antegrade approach.
Retrograde approach.

Procedure 1-LM (3.5X14MM DES followed by 4.0X12MM NC) 2-RCA antegarde attempt 130 cm F/C with XT-A able to pass into small PDA, need RV2x12 mm anchoring & F/C could pass-down to PDA, after tip injection & POBA 1.2x12 & 2.5x15 mm RCA-m-d, another CTO from PDA-PL ,epicardial collateral from CX-d to PL. broken-tip Sion & Suoh-03 finally able to pass at 150 cm F/C pushing all retrogarde went-out, 2nd time epicardial collateral channel passing, F/C unable to pass and 1.6F Caravelable to pass smoothly, after Sion reaching distal CTO at PL, after Sion reaching distal CTO at PL, puncture with Gaia-2nd, UB3, XT-a went into subintimal space, R-CART2.5x15 mm & 3x15 mm at RCA-m-d, XT-A able to pass to RCA-p, Caravel difficultpushing into 7F AL1 guide, therefore 6F Gazella was introduced to RCA-m forengulfing Caravel M.C. & RG-3 externalization, IVUS guided lesionprepared &2.5x15mm, 3x15 mm balloon, DES 2.5x38 mm for RCA-PL, 3x38 mm mid-distal, leaving 1 cm gap without full-metal jacket, LM-shaft DESlongitulinal fore-shortening reverse by 4x12 mm POT, small segment not coveredby DES, but IVUS revealed optimal results MLA > 8 mm2.

MOVIE-0003.wmv

MOVIE-0004.wmv

New Microsoft PowerPoint Presentation.pptx

•Snuffbox is a viable option for complexPCI (e.g CTO)•LM diseased patient with RCA CTO, LM PCIis preferred 1st•Suoh-03 have very good trackability andcrossability in sever tortuosity•Caravel microcatheter have excellentcrossing profile(1.9 FR) and tip taper (1.4 FR)•Guide extension (guidezilla) is used whenthe retrograde microcatheter cannot reach the antegrade guiding

CORONARY - Chronic Total Occlusion
LM Disease & RCA CTO PCI and How to Manage Difficulties
Mohamed Elsayed Radwan¹
Kaohsiung Chang Gun Memorial Hospital, Taiwan¹,

[Clinical Information] - Patient initials or identifier number: 76548 -Relevant clinical history and physical exam: 31 gentleman, Hypertension, smoker, 2019/5/30, unstable angina, PCI tom-LAD (Firebird 3.5x33m), d-LCX (Firebird 2.5X18).with RCA CTO and os-RCA 70-80% stenosis, 2019/6/21, PCI to os-RCA(Firebird 3.5x18mm), failure RCA CTO, 2019/8/7, presented with NSTEMI, EF 66%, Serum creatinine 92 umol/l, trop 0.45 ug/l. -Relevant test results prior to catheterization: - Relevant catheterization findings:
[Interventional Management] - Procedural step: Catheterization thought Left snuffbox artery (d-RA) and RT radial artery – guiding catheters (7 FR XB 3.5 for LCA and 7 FR AL 1 for RCA).Ø Plan:• PCI to LM • PCI to RCA CTO Antegrade approach. Retrograde approach. Procedure 1-LM (3.5X14MM DES followed by 4.0X12MM NC) 2-RCA antegarde attempt 130 cm F/C with XT-A able to pass into small PDA, need RV2x12 mm anchoring & F/C could pass-down to PDA, after tip injection & POBA 1.2x12 & 2.5x15 mm RCA-m-d, another CTO from PDA-PL ,epicardial collateral from CX-d to PL. broken-tip Sion & Suoh-03 finally able to pass at 150 cm F/C pushing all retrogarde went-out, 2nd time epicardial collateral channel passing, F/C unable to pass and 1.6F Caravelable to pass smoothly, after Sion reaching distal CTO at PL, after Sion reaching distal CTO at PL, puncture with Gaia-2nd, UB3, XT-a went into subintimal space, R-CART2.5x15 mm & 3x15 mm at RCA-m-d, XT-A able to pass to RCA-p, Caravel difficultpushing into 7F AL1 guide, therefore 6F Gazella was introduced to RCA-m forengulfing Caravel M.C. & RG-3 externalization, IVUS guided lesionprepared &2.5x15mm, 3x15 mm balloon, DES 2.5x38 mm for RCA-PL, 3x38 mm mid-distal, leaving 1 cm gap without full-metal jacket, LM-shaft DESlongitulinal fore-shortening reverse by 4x12 mm POT, small segment not coveredby DES, but IVUS revealed optimal results MLA > 8 mm2. MOVIE-0003.wmv MOVIE-0004.wmv New Microsoft PowerPoint Presentation.pptx - Case Summary: •Snuffbox is a viable option for complexPCI (e.g CTO)•LM diseased patient with RCA CTO, LM PCIis preferred 1st•Suoh-03 have very good trackability andcrossability in sever tortuosity•Caravel microcatheter have excellentcrossing profile(1.9 FR) and tip taper (1.4 FR)•Guide extension (guidezilla) is used whenthe retrograde microcatheter cannot reach the antegrade guiding

E-Science Station