An 8 Fr sized sheath was inserted into the right femoral artery and a 6 Fr sized sheath was also inserted into the left brachial artery for bidirectional approach. Initially, by using the Finecross microcatheter, antegrade approach with Miracle 6 wire was tried into Lt. SCA (Figure 1). However, we failed. And then, antegrade approach with another Conquest pro 12 wire was also failed. Retrograde approach with Conquest pro 12 wire was tried to pass the Lt. SCA lesion (Figure 2), but failed again. After that, antegrade approach with a 0.014 inch Peri 30G wire was tried into Lt. SCA. However, we failed again. Finally, a 0.014 inch Astato XS 9-12 wire could cross Lt. SCA ( Movie 2). And then, we checked wire position using VU IVUS. After IVUS check-up, we performed several small predilatations with an Amadeus 2.0x20mm balloon at Lt.SCA. After exchanging Astato XS 9-12 wire into a 0.014 inch Flexi-cut wire (Figure 3), several small predilatations with an Amadeus 2.0x20mm balloon at Lt. SCA were done ( Movie 3). And then, two guiding catheters (8 Fr and 6 Fr) were overlapped and we aspirated debris to avoid distal embolizations ( Movie 4). After aspiration, a 7.0x39 mm sized Palmaz Cornithian stent was deployed (Figure 4). Final angiogram showed good result ( Movie 5). |
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