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Anterograde approach “Septal to septal” for proximal LAD CTO lesion
- Operator: Seung-Whan Lee, MD

A 50 year-old man was admitted for effort angina. He had a history of hypertension, diabetes, and smoking with 20 pack-years. The trans-thoracic echocardiography revealed normal LV systolic function (EF=55%).

Baseline coronary angiogram

1. A left coronary angiogram showed TIMI 0 flow proximal portion of LAD with connection from septal to septal anastomosis. (Figure 1)
2. A right coronary angiogram showed normal.

Procedure

Firstly, left coronary was inserted with a 8 Fr XB 3.5 SH guiding catheter and right coronary was inserted with JR 3.5 5 Fr diagnostic catheter.

Initially, by using a Coronary Micro-Guide catheter, 0.014 inch Fielder FC wire was tried into septal branch to the other spetal branch to the distal part of LAD CTO lesion. (Figure 2, Figure 3, Figure 4) However, the wire could not pass through the proximal side. For antegrade direction, 0.014 inch Miracle 6g wire through a Finecross® 0.014 inch 1.8 Fr -175cm Coronary Micro-Guide catheter was tried and passed the proximal part of LAD. (Figure 5, Figure 6, Figure 7)

And then, after removal of microcatheter, balloon dilatation with Sprinter 1.25*15mm sized balloon and Sequent 2.5*15mm sized balloon was performed. Two consecutive Xience-V stents (2.75*28mm + 3.0*28mm) were deployed. (Figure 8, Figure 9, Figure 10)

Final angiogram showed successful stent expansion without periprocedural complications. (Figure 11)

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