Case 221: Manual of CTO PCI - Reverse CART in the LIMA
Автор: Manos Brilakis
Загружено: 2023-06-16
Просмотров: 4399
Описание: A prior CABG patient was referred for PCI of an LAD CTO. All prior bypass grafts, including the LIMA-LAD were occluded. Two stent layers had been previously placed from the LAD into the diagonal branch making the proximal cap ambiguous. A primary retrograde approach was attempted but a retrograde wire could not puncture through the previously placed stents, even after doing intravascular lithotripsy from the LAD into the diagonal. Coronary CTA showed two stent layers and heavy calcification. A repeat retrograde attempt was performed advancing the retrograde guidewire into the LIMA stump. After doing both antegrade and retrograde Carlino a retrograde Sion black wire was advanced extraplaque into the LIMA, followed by successful crossing using reverse CART. After wire externalization, antegrade wiring of the LAD through a Sasuke, removal of the retrograde gear and stenting of the LIMA-LAD a nice final result was achieved.
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