> Cases

1st Operator: Seung-Whan Lee / 2nd Operator: Chang Hoon Lee / 3rd Operator: Gyung-Min Park

Brief Case Summary

A 76 year-old female admitted for intermittent chest pain during hemodialysis. She had a previous history of PCI with DES at proximal to distal LCX and distal RCA to PDA 5 years ago. And she underwent PCI with DES for mid LAD lesion 2 months ago. Her conventional coronary risk factors were diabetes, hypertension, and dyslipidemia.

Past Medical History

  • Previous MI: N
  • Previous CABG : N
  • Previous PCI: Y / ERSD on HD
  • Other: History of VF arrest due to hyperkalemia
    PAOD at Rt. CFA, s/p percutaneous transluminal angioplasty (‘13)

Demographic Characteristics

  • Diabetes: Y
  • Hypertension: Y
  • Hyperlipidemia: Y
  • Smoking: N
  • Family History: N
  • Age: 76
  • Sex: Female

Clinical Presentation

Stable angina

Non-invasive Studies

Echocardiography

Akinesia of basal inferior wall with near normal LV systolic function, Moderate to severe functional MR

Treadmill test

Not done

Thallium SPECT

Reversible large sized moderately decreased perfusion in basal inferoseptal and mid-basal inferior wall

Cardiac Catheterization Findings

  • The left coronary angiogram showed tight mid LAD lesion (PCI was done) and patent previous stent at proximal to distal LCX. And the collateral flow from septal branches to PDA was observed.
  • The right coronary angiogram showed chronic total occlusion of mid RCA. (SYNTAX score 16)

Case Notes

Target Lesion(s)

mRCA CTO

Adjunctive Medication

  • ASA: Y
  • LMWH: N
  • Clopidogrel: Y
  • Heparin: N
  • Nitrates: N
  • IIb/IIIa: N
  • Other: beta blocker, calcium channel antagonist, angiotensin receptor blocker, statin

Teaching Points

  • Anterograde or retrograde approach of total occlusion of RCA
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