Case 200: Manual of CTO PCI - Three in one
Автор: Manos Brilakis
Загружено: 2022-11-18
Просмотров: 2550
Описание: A morbidly obese patient (BMI =49) presented with exertional angina and dyspnea and had a markedly abnormal stress test. Coronary angiography showed 3 vessel CTOs (mid LAD, proximal circumflex, mid RCA). He declined surgery and was referred for PCI. The LAD CTO was easily crossed using antegrade wiring and was successfully stented. Given low use of contrast and radiation it was decided to also attempt PCI of the mid RCA during the same procedure. The RCA CTO had an ambiguous proximal cap with bridging collaterals. A septal collateral was successfully crossed from the LAD to the PDA, followed by retrograde wiring attempts that resulted in retrograde wire perforation. The retrograde wire was advanced into an acute marginal branch and served as marker of the distal true lumen. A Pilot 200 wire was advanced antegradely into the same acute marginal and then redirected to the distal RCA. The mid RCA lesion was balloon uncrossable requiring use of a Guideliner and a Sapphire Pro 1.0 mm balloon, but was eventually successfully crossed, predilated and stented. The patient had an uneventful recovery.
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