Antegrade Approach for mRCA CTO lesion
- Operator : Etsuo Tsuchikane
|Antegrade Approach for mRCA CTO lesion|
|- Operator: Etsuo Tsuchikane, MD|
|A 46-year-old man was admitted to our hospital for treatment of CAD. He had a history of DM, hypertension, smoking and dyslipidemia. Treadmill test was negative and trans-thoracic echocardiography showed normal LV systolic function without wall motion abnormality (EF=66%).However, coronary CT angiography revealed mRCA total occlusion.|
|Baseline coronary angiogram|
|1. A right coronary angiogram showed total occlusion of mRCA with collateral flow from to LAD( Movie 1).
2. A left coronary angiogram showed mild diffuse narrowing of pLAD( Movie 2).
|Right and left coronary artery was cannulated with a 7 Fr AL 1 SH guiding catheter and a 5Fr JL 3.5 diagnostic catheter, respectively. By using 0.014Ħħ Fielder XT and 0.014Ħħ Ultimate wire were tried to pass through pRCA CTO lesion antegradely (Figure 1) and passed successfully (Figure 2). Several sequential balloon dilatations with Maverick 1.5*15mm and 2.5*15mm were performed (Figure 3, Figure 4).After IVUS examination, We deployed PROMUS Element 2.5 * 32 mm and PROMUS Element 3.0 * 38 mm stent (Figure 5, Figure 6, Figure 7). After deploying stent, high pressure ballooning with Quantum 3.5 * 15mm was done. The final angiogram showed well positioned and expanded stent with good distal run-off flow ( Movie 3).|
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