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.

CASE20191025_005
CORONARY - Chronic Total Occlusion
If You Keep Knocking, You Will Find Open Door.
Afrah Yousif Haroon1
National Heart Institute, Malaysia1,
[Clinical Information]
- Patient initials or identifier number:
ASS
-Relevant clinical history and physical exam:
A 71 years male, has  recent anterior MI, successfully thrombolysedwith Metalyse. April 2019.Had previous CABG 1998 for TVD (CTO LAD)cardiovascular risk factor are Diabetes Mellitus , Hypertension, HyperlipidemiaEcho: EF 30-35%, multiple RWMAMSCT-CAG: Occluded all SVG grafts.Nuclear Scan: Infracted distal LAD, under perfused butviable myocardium at Proximal and mid LAD & RCAAdvised for redo-CABG, but case declined by surgeon in view of distal LAD infarct.
echo.mpg
echo2.mpg
-Relevant test results prior to catheterization:
Blood test : Troponin -T 1320Renal profile & full blood count were normal.angiogram: severe TVD CTO LAD, CTO RCA, Stumps all SVG: since 2016
cto lad.mpg
- Relevant catheterization findings:
Double puncture, RRA 7F sheath & RFA 7F sheath.EBU 3.5/7F Left systemAL1/7F RCAUpon engage RCA notice ST changes, BP drop and patientdeveloped chest pain, decided for PCI   to RCA,Guide SAL 1.0/6F , wire pilot 200 in Corsair microcathetr, cross lesion, change to floppy wirepredilated with sapphire 2.5/12stented distal to mid RCA with synergy 3.0/48stented mid to proximal RCA with synergy 4.0/48up sized distally with NC 3.5/20 and proximal with NC 4.0/20ST-segment elevation resolved
rca.mpg
nuckle wire.mpg
[Interventional Management]
- Procedural step:
IVUS guided fielder XT wire in Corsair MC•                   Sion wire to septal branch•                   Predilated proximal LAD to septal with 2.5/15balloon to allow IVUS to pass down.•                   Antegrade approach IVUS guided to assess entrypoint to LAD, but not useful, cannot see.•                   Decided for retro-grade approach using septalbranch since it gives collateral to LAD•                   With corsair used different wire (fielder XT-R,Souh 03, Sion, Sion black), unable to cross the curve.•                   Decided for antegrade again, ADR technique usingknuckle wire to create tract to true lumen•                   Repeated knocking,,With angio checking by injection from micro-catheterTract seen to LADConquest Pro 50GAIA 3 cross to LADPredilated Sapphire 2.0/15IVUS: assessed the vessel size,
Guidezela  used to  deliver synergy stent 2.5/48 to d-mLAD3.5/28 synergy stent -LAD-LMSUps sized with 2.5/20 distally, 3.5/20 mLAD, 4.0/15 pLAD toostium & 5.0/8 LMS (POT)

guidezela to pass dLAD stent.avi
Corasir septal to show retrograde.avi
- Case Summary:
Learning points•                   CTO age does not matter the successfulness of the procedure•                   The need to understand different techniques CTO angioplasty.•                   Good skill will make high risk & complex procedure safe and simple•                   The use to assistance equipment to facilitate(IVUS, Guidezela) & end with successful procedure.•                   Patient safety  & minimize procedural complications 
like off