Case presentation

This 49-year old male was admitted with effort angina for 1 year. His coronary risk factors were smoking and hypercholesterolemia. The baseline coronary angiogram showed chronic total occlusion (CTO) in middle right coronary artery (RCA) (Figure 1).

Procedures

A 7F AL1 guiding catheter was engaged into the RCA ostium and a 0.014 inch Miracle guide wire was successfully passed through the CTO lesion (Figure 2). Then a 3.0 x 20 mm Voyager^TM RX balloon was placed in the lesion and dilated up to 3.0mm (8 atm) (Figure 3). The following angiogram showed significant residual stenosis with coronary dissection (Figure 4). Three Cypher stents were deployed from distal to proximal segment consecutively (3.0 x 33 / 3.5 x 33/ 3.5 x 33 mm) (Figure 5, Figure 6. Figure 7). Additional high pressure balloon dilatations were performed using 3.0 x 20 mm Sprinter balloon up to 3.36 mm (16 atm) (Figure 8, Figure 9, Figure 10). The final coronary angiogram showed successful result (Figure 11).

Take home message

The Voyager^TM Rx balloon was very useful in the treatment of complex lesion intervention like chronic total occlusion for its new low profile, tapered tip design with a lower profile shaft, more flexible markers, and short taper balloon technology.