Slides TCTAP

[April 25] CTO LIVE_Asan Medical Center, Seoul, Korea: Case #2

- Operator : Yasushi Asakura

1st Operator: Yasushi Asakura / 2nd Operator: Yong-Rak Cho

Brief Case Summary

A 49 year-old male was admitted for the evaluation of Coronary CT angiography abnormality. The coronary angiography was performed, which reveled significant stenosis LM to proximal LAD, and CTO lesion proximal RCA. Then, LM to proximal LAD lesion was stented.

Past Medical History

  • Previous MI: N
  • Previous CABG : N
  • Previous PCI: Y
  • Other: Hyperlipidemia, Current smoker

Demographic Characteristics

  • Diabetes: N
  • Hypertension: N
  • Hyperlipidemia: Y
  • Smoking: Y
  • Family History: N
  • Age: 49
  • Sex: Male

Clinical Presentation

Silent ischemia

Non-invasive Studies

Echocardiography

No RWMA with normal LV systolic function (EF 62%)

Treadmill test

Not done

Thallium SPECT

Normal

Cardiac Catheterization Findings

  • The coronary angiography showed total occlusion at proximal RCA with grade 3 collateral flow from distal LAD.
  • Significant stenosis of LM to proximal LAD was also shown.
  • SYNTAX score: 29

Case Notes

Target Lesion(s)

Proximal RCA

Adjunctive Medication

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

Teaching Points

  • Anterograde or retrograde approach of total occlusion of RCA

Coronary Angiography

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