Slides
Antegrade Approach for mRCA CTO lesion
- Operator : Etsuo Tsuchikane
Antegrade Approach for mRCA CTO lesion |
- Operator: Etsuo Tsuchikane, MD |
A 46-year-old man was admitted to our hospital for treatment of CAD. He had a history of DM, hypertension, smoking and dyslipidemia. Treadmill test was negative and trans-thoracic echocardiography showed normal LV systolic function without wall motion abnormality (EF=66%).However, coronary CT angiography revealed mRCA total occlusion. |
Baseline coronary angiogram |
1. A right coronary angiogram showed total occlusion of mRCA with collateral flow from to LAD( Movie 1). 2. A left coronary angiogram showed mild diffuse narrowing of pLAD( Movie 2). |
Procedure |
Right and left coronary artery was cannulated with a 7 Fr AL 1 SH guiding catheter and a 5Fr JL 3.5 diagnostic catheter, respectively. By using 0.014¡± Fielder XT and 0.014¡± Ultimate wire were tried to pass through pRCA CTO lesion antegradely (Figure 1) and passed successfully (Figure 2). Several sequential balloon dilatations with Maverick 1.5*15mm and 2.5*15mm were performed (Figure 3, Figure 4).After IVUS examination, We deployed PROMUS Element 2.5 * 32 mm and PROMUS Element 3.0 * 38 mm stent (Figure 5, Figure 6, Figure 7). After deploying stent, high pressure ballooning with Quantum 3.5 * 15mm was done. The final angiogram showed well positioned and expanded stent with good distal run-off flow ( Movie 3). |
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