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CASE20191022_002
| CORONARY - Chronic Total Occlusion | |
| Passing Through the CTO Lesion by Expansion of Small Balloon to Rupture Method | |
| Wenduo Zhang1, Xue Yu1 | |
| Beijing Hospital, China1, | |
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[Clinical Information]
- Patient initials or identifier number:
580195
-Relevant clinical history and physical exam:
This is a male patient, 62 years old, was admitted to the hospital in October 2019 for more than one year because of chest tightness after activity. Two months ago, the external coronary angiography showed Mlad CTO, and PCI was unsuccessful. In the past 4 years of type 2 diabetes, 2 years of hypertension, 40 years of smoking history, 20 per day. Deny other medical history. Deny family history.There was no special positive sign in physical examination.
-Relevant test results prior to catheterization:
No segmental wall motion abnormality was found in echocardiography, LVEF was 60%, serum creatinine level was normal, LDL-c 2.0 mmol/L
- Relevant catheterization findings:
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[Interventional Management]
- Procedural step:
We used guiding with 7F Medtronic AL 1.0 by right femoral artery and cordis 6F XB RCA right radial artery. First we tried the FielderXT with support by Terumo Fincross 130mm 1.7F£¬but not find microchannels failed to pass lesion. Then we changed to conquest pro wire. The wire can pass the lesion, but not got into the true lumen of dLAD. Then we used Gaia 3rd wire supported by Alport microcatheter 1.7F. By the parallel wire technique, the Gaia 3rd wire got into the true lumen of dLAD. But the two microcatheters cannot pass the occlusion, even supported by guidzilla(5 in 6). So that we changed to use balloon. But TAZUNA 1.5-10 and Sapphire II 1.0-10mm cannot pass even supported by guidzilla(5 in 6). We used the Medtronic 1.25-12mm which can only reach the mid of the CTO lesion, then we inflated the balloon to 12ATM, we saw the balloon raptured, the contrast was saw at D2. After that blow up£¬the new same balloon passed the CTO lesion supported by guidzilla(5 in 6). Then we sequential expanded the CTO lesion by 1.25-15mm,1.5-1.5mm,2.0-15mm. But distal coronary blood flow only reach TIMI 2 grade. We wanted to use the IVUS, but not passed. By 2.5mm balloon expansion, IVUS passed the lesion. From IVUS images£¬we can see severe calcification in p-mLAD and CTO lesion, and the segment of the guide wire through the lesion was subintimal. Supported by guidzilla(5 in 6), we use 2.5-15mm expanded to burst, and implanted two stent(2.5-22mm,3.0-26mm) sequentially.
 PGais3rd5.mp4 Finalienable¡¢.mp4- Case Summary:
It was a severe calcification CTO lesion. Only wire can pass the lesion. Also we used the strong support by 7F Medtronic AL 1.0 and guidzilla(5 in 6), the smallest balloon and 1.7F microcatheter cannot pass the lesion.We also want to apply the rotational atherectomy. However£¬for microcatheter not passed the lesion, the rota wire also was impossible to pass the lesion. For the kind of lesion, to inflated the smallest balllon to rapture might be a choice. The impact force produced by the instant rupture of the balloon can loosen the calcified components in the lesions, which is conducive to the passage of the instrument.
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