Retrograde approach "Reverse CART technique" in pLAD CTO blesion
- Operator : Etsuo Tsuchikane
|Retrograde approach "Reverse CART technique" in pLAD CTO blesion|
|- Operator: Etsuo Tsuchikane, MD|
|A 59 year-old man was admitted to hospital for treatment of CAD. He had a history of MI and had undergone successful stenting for proximal, distal RCA and RI lesion, but failed PCI for pLAD CTO lesion at 2011.
He had coronary risk factors such as dyslipidemia and current smoking history with 40 pack-years. As a non-invasive function test, thallium SPECT was done and showed partial reversible large sized perfusion defect of LAD territory. Treadmill test was negative. The trans-thoracic echocardiography showed akinesia of LAD territory with normal LV systolic function (EF=58%).
|Baseline Coronary Angiogram|
|1. A left coronary angiogram showed total occlusion of pLAD with collateral flow from to PDA and patent stent at RI.( Movie 1, Movie 2)
2. A right coronary angiogram showed patent stent at pRCA and dRCA.
|Left coronary artery was cannulated with a 7 Fr XB 3.5 guiding catheter by right femoral artery and right coronary artery was positioned with 8 Fr AL1 guiding by left femoral artery. A SION 0.014 inch 175cm guidewire with a Corsair¢ē 0.014 inch 2.6 Fr -135cm microcatheter was approached to retrograde pathway to LAD. ( Movie 3) Due to tortuosity, the guidewire was changed to XT-R 0.014 inch-190cm. An XT-R 0.014 inch 190cm guidewire with a Corsair¢ē 0.014 inch 2.6 Fr -135cm microcatheter was successfully advanced to proximal LAD by retrograde approach. (Figure 1) By using Extension wire 0.014 inch 150cm, we exchanged XT-R 0.014 inch guidewire to SION 0.014 inch 175cm guidewire. By using Ryujin 2.5 X 15mm balloon, we advanced Corsair microcatheter to LAD. A Fielder FC 0.014 inch 180cm guidewire passed distal LAD by antegrade approach. At this point, the reverse-CART technique was performed and a Ryujin 2.5 X 15mm balloon was introduced in an antegrade manner. ( Movie 4) The 0.014 inch RG3 Blue one 330cm guidewire was inserted from the left guiding catheter to the right guiding catheter and it formed a wire loop (retrograde wire externalization). From the guidewire tip outside the right sheath, predilatation with the Ryujin 2.5 X 15mm balloon was performed.(Figure 2) After the IVUS examination, three drug-eluting stent were deployed (Xience V 3.0 X 12mm at proximal LAD, Xience prime 2.5 X 33mm, and Xience V 2.5 X 23mm in the distal LAD, sequentially) The final angiogram showed successful revascularization at the LAD CTO lesion.(Figure 3, Figure 4)|
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