Retrograde Approach Using "Reverse CART Technique" for Diffuse RCA CTO Lesion

- Operator : Etsuo Tsuchikane

Retrograde Approach Using "Reverse CART Technique" for Diffuse RCA CTO Lesion
- Operator: Etsuo Tsuchikane, MD
Case Presentation
A 55-year-old gentleman presented with effort chest pain about a month ago. At that time we checked his coronary angiogram. It showed tight stenosis at pLAD and pLCX and total occlusion of RCA. Then we performed PCI at pLAD and pLCX. His coronary risk factors were diabetes, dyslipidemia and ex-smoking. The physical examination was unremarkable. The ECG and cardiac enzymes were normal. The transthoracic echocardiography showed normal LV systolic function (EF=67%) with regional wall motion abnormality of RCA territory.
Baseline Coronary Angiography
1. Left coronary angiogram showed patent previous stents at pLAD and pLCX. It also showed collateral flow from septal branches of LAD to RCA ( Movie 1, Movie 2).
2. Right coronary angiogram showed total occlusion from the proximal RCA ( Movie 3).
Procedure
Right coronary artery was cannulated with a 7 Fr JR 4 SH guiding catheter and left coronary artery was positioned with a 7 Fr EBU 3.5 SH guiding catheter through the bi-femoral approach. After engaging guiding catheter into coronary arteries, we checked image by simultaneous injection of right and left coronaries ( Movie 4). Initially, by using the Corsair¢ç 0.014 inch 2.6 Fr 150cm microcatheter with NEO¡¯s (SION) 0.014 inch 180cm guidewire was tried via LAD septal channel by retrograde approach. And then, guidewire was changed to NEO¡¯s (Gaia second) 0.014 inch 1.8 Fr 180cm. Thereafter the wire was advanced into RCA by retrograde approach ( Movie 5) and introduced into the RCA guiding catheter. We performed several balloon dilatation with Sprinter legend 1.25x12mm and 2.5x15mm sized balloon on pmRCA (Figure 1). After several predilation, we sequentially deployed a XIENCE PRIME LL stent 2.5 x 33mm and 3.0x28mm at the pmRCA (Figure 2, Figure 3). Final angiogram showed successful stent expansion without periprocedural complications ( Movie 6).

Comments

  • Shih-Hung Chan 2013-09-09 Excellent results!
  • Xuchen Zhou 2013-09-10 Dr.Tsuchikane is an excellent CTO PCI master. I will introduce such patients like that to him for the PCI treatment. I will never do this retrograde CTO PCI if I were in Japan because there are so many excellent CTO PCI doctors. By the way, the equipments for CTO PCI is so good that let us could not keeping to admire the Japanese tube&wire tequnichers.

Leave a comment

Sign in to leave a comment.