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Anterograde Approach for mid LAD CTO Lesion
- Operator: Seung-Whan Lee, MD
Case Presentation
A 29 year-old female was referred for CTO intervention. She had suffered effort chest pain for 6 months. The coronary angiogram showed totally occluded lesion at mid-LAD. She was a heavy smoker and used to take oral contraceptives. The physical examination was normal. The ECG and cardiac enzymes were unremarkable. Thallium SPECT showed reversible large sized perfusion defects at LAD territory. There was no regional wall motion abnormality on echocardiography.
Baseline Coronary Angiography
  1. The left coronary angiogram showed total occlusion at mLAD and grade 2 collateral flow from LCx was seen ( Movie 1, Movie 2).
  2. The right coronary artery gives some collateral flow to LAD ( Movie 3).
Procedure
Right coronary artery was cannulated with a 6 Fr JR4 diagnostic catheter and left coronary artery with 7 Fr XB 3.0 SH guiding catheter through the bi-femoral approach, respectively. We tried antegrade approach through mLAD by using several wires, such as a 0.014 inch Sion, Fielder XT, Fielder XT-A, Gaia second, and Gaia third, with Finecross 0.014 inch 1.8 Fr 130cm microcatheter, only to fail ( Movie 4). Using 0.014 inch Conquest pro 12 with Corsair 0.014 inch 2.6 Fr 150 cm microcatheter, LAD was successfully wired ( Movie 5). The Conquest pro wire was replaced with 0.014 inch 300 cm BMW wire, before predilatation was performed with Emerge 1.2 x 12mm, and Sprinter legend 2.0 x 20mm balloons. (Figure 1). Xience Xpedition 2.75 x 38 mm was implanted into mLAD (Figure 2). Postdilatation using an Empira NC 2.75 x 15mm balloon was performed and the BMW wire was removed (Figure 3). The following coronary angiogram showed well expanded stents at mLAD with good distal flow without any complication ( Movie 6, Movie 7).
Jabar Ali2015-09-07
excellent case and i enjoyed it alot
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