Slides Imaging & Physiology IVUS
Chronic Total Occlusion; Side Branch IVUS-Guided CTO Intervention
- Operator : Shigeru Saito
Chronic Total Occlusion; Side Branch
IVUS-Guided CTO Intervention |
- Operator: Shigeru Saito, MD |
Clinical Presentation |
A 55 year-old man had old MI that occurred in 2001 and recently presented effort related chest pain for 3 months. But PCI was failed in other hospital because of failure of guidewire passage. So, he was referred to our hospital. Coronary risk factors were smoking. Initial cardiac enzyme levels showed normal range. His baseline ECG showed sinus bradycardia. Echocardiographc finding showed reduced global left ventricular systolic function (ejection fraction = 49%) and akinesia of mid anteroseptal wall. |
Baseline Coronary Angiography |
Coronary angiogram showed a total occlusion involving mid LAD with TIMI G0 flow and collateral flow grade II from RCA. (Figure 1 and Figure 2) |
Procedure |
RCA was engaged with 6F JR4 guiding catheter and
left coronary artery was engaged with 8F XB 3.5 guiding catheter. At first,
a 0.014¡± Finecross microcatheter with Runthrough-hypercoat guidewire (Terumo,
Japan) was introduced into the left ventricular septal branch through
the RCA (Figure
3), but it failed to pass through the septal artery to LAD. Subsequently
a Fielder FC guidewire (Asahi Intecc, Japan) and a Miracle 3 guidewire
(Neo¡¯s, Asahi, Japan) with Finecross microcatheter was advanced to mid
LAD lesion retrogradely but all guidewire failed to pass the total segment
retrogradely (Figure
4, Figure
5). |
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