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!
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CASE20200925_006
| Complex PCI - Chronic Total Occlusion | |
| Complex PCI of CTO of LCX Using Provisional Stenting Make It Simple | |
| Islam Elsayed Shehata1 | |
| Zagazig University, Egypt1, | |
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[Clinical Information]
- Patient initials or identifier number:
A.E.H.
-Relevant clinical history and physical exam:
50Ys old male patient No family history of IHD NSTEMI Hypertensive Not diabetic Dyslipidemic Hemodynamically stable Pulse: 80 bpm BP: 130/80 mmHg LL: No Oedema JVP: Not raised Chest: clear Ht: S1, S2 & 0 Local Exam: free  Video of PCI to LCX CTO.mp4-Relevant test results prior to catheterization:
T-wave inversion in V4, V5 & V6 of ECG wall motion abnormalities in lateral LV wall in TTE. - Relevant catheterization findings:
LCX shows osteal CTO
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[Interventional Management]
- Procedural step:
Rt. femoral approach using modified Seldinger technique. Rt. femoral sheath 6F was inserted Lt. and Rt. Judkin catheters used for coronary angiography or Lt. and Rt. coronary arteries. LM: was normal and bifurcates into LAD & LCX. LAD: was atherosclerotic vessel without significant lesions LCX: was totally occluded from its ostium with retrograde filling from Rt. system. RCA: Atherosclerotic vessel without significant lesion Guiding catheter : JL4 Guide wire: BMW universal introduced distally into LCX and LAD. Predilatation balloon: introduced over the guide wire into LCX CTO then multiple inflation by compliant balloon (1.5 X 15 mm) inflated at 14 ATM. Stent: Promus Premiere (3X 20 mm) positioned at ostium of LCX and inflated at 14 ATM with TIMI III flow and no complications.    - Case Summary:
Take home message: 1-Simplify your procedure as much as possible for patient safety. 2-Take your time to put your plan before intervention of CTO lesion. 3-Protect your side branch by another wire during intervention with bifurcational lesions. 4-Start by soft wire for CTO lesion then use wire escalation accordingly. 5-Provesional one stent technique can e used in certain cases of osteal LAD or LCX CTO with consideration to anatomical variations. 6-Be ready to change your plan if any complication occurs. |
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