Slides TCTAP

[April 25] CTO LIVE_Asan Medical Center, Seoul, Korea: Case #4

- Operator : Toshiya Muramatsu

1st Operator: Toshiya Muramatsu / 2nd Operator: Han Young Jin / 3th Operator: Hyuck Jun Yoon

Brief Case Summary

A 55 year-old male was admitted for the evaluation of abnormality in a coronary angiographic CT with a health checkup. Echography showed normal systolic function(EF:71%) without reginal wall motion abnormality. The coronary angiography showed the proximal LAD CTO with the grade 3 collateral flow from the PDA.

Past Medical History

  • Previous MI: N
  • Previous CABG : N
  • Previous PCI: N

Demographic Characteristics

  • Diabetes: N
  • Hypertension: N
  • Hyperlipidemia: N
  • Smoking: N
  • Family History: N
  • Age: 62
  • Sex: Male

Clinical Presentation

Silent ischemia

Non-invasive Studies

Echocardiography

No regional wall motion abnormality with normal systolic function (EF 71%)

Treadmill test

none

Thallium SPECT

none

Cardiac Catheterization Findings

  • The left coronary angiography showed the proximal LAD CTO with the grade 3 collateral flow from the PDA.
  • The right coronary angiography showed mild diffuse rPDA stenosis.
  • SYNTAX Score : 26.5

Case Notes

Target Lesion(s)

Mid LAD CTO

Adjunctive Medication

  • ASA: Y
  • LMWH: N
  • Clopidogrel: N
  • Heparin: N
  • Nitrates: N
  • IIb/IIIa: N
  • Other: beta-blocker, statin

Teaching Points

  • PCI with total occlusion of LAD
  • Anterograde or retrograde approach of LAD total occlusion

Coronary Angiography

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