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Anterograde Approach for RCA CTO Lesion
- Operator: Seung-Jung Park, MD
Case Presentation
A 62-year-old male patient was admitted for efforting chest pain from 1 year ago in other hospital. His coronary risk factor was current-smoking and hypertension. He had underwent coronary angiography in other hospital which shows RCA CTO lesion. RCA CTO was tried but failed at that time. In spite of medical treatment, he consistently feels efforting chest pain. He was referred in our hospital for RCA CTO PCI.
Baseline Coronary Angiogram
  1. Left coronary angiogram showed near normal LAD and LCX. It also showed epi cardiac collateral flow from septal branch to PDA and LA branch to PL ( Movie 1).
  2. The right coronary angiogram showed proximal RCA CTO ( Movie 2).
Procedure
Right coronary artery was engaged with a 7 Fr AL 1 guiding catheter and left coronary artery was positioned with an 7 Fr XB 3.0 guiding catheter through the bi-femoral approach. We tried to pass the CTO lesion by anterograde approach using Fielder XT-R wire with Corsair 135cm microcatheter ( Movie 3). Lastly, we tried to pass the CTO lesion by anterograde approach with Gaia 2 wire. And then, we successfully pass wire into RCA CTO lesion ( Movie 4). After advancement of Corsair microcatheter, we performed several balloon dilatations at proximal to middle RCA using Tazuna 1.25 x 15 mm and ROVL 3.0 x 15 mm ( Movie 5). After predilatation, we changed Gaia 2 wire to Runthrough wire and deployed three Ultimaster stents (3.0x38 mm, 3.5x38mm, 3.5 x28mm distal to proximal RCA, Movie 6) sequentially. After stenting, we inflated Raiden 3 4.0 x 20mm upto 20atm (4.2mm) at proximal RCA and 16atm (4.1mm) at mid RCA ( Movie 7). The final angiogram showed successful revascularization at RCA CTO lesion ( Movie 8).
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