Slides
Antegrade approach for total occlusion of LAD stent
- Operator : Etsuo Tsuchikane
| Antegrade approach for total occlusion of LAD stent |
| - Operator: Etsuo Tsuchikane, MD |
| A 67 year old gentleman was admitted due to syncope. He had a history of hypertension. In addition, he underwent PCI for pLAD (Cypher3.5*33mm), pLCx (Taxus3.0*28mm), and pRCA(Taxus 3.5*32) 6 years ago. Thalium spect showed reversible perfusion defect at LAD territory. |
| Baseline coronary angiogram |
1. A right coronary angiogram showed patent previous RCA stent ( Movie 1, Movie 2).2. A left coronary angiogram showed total occlusion of LAD stent with TIMI 0 flow with collateral II from septal branches ( Movie 3). |
| Procedure |
| Firstly, left coronary was cannulated with an 8 Fr XB 3 SH guiding catheter. Initially, by using the ASAHI Corsair ® 0.014 inch 2.6 Fr -135cm Coronary Micro-Guide catheter with soft wire, we tried to pass to LAD lesion anterogradely but it couldn’t pass through. Thereafter, we changed 0.014 inch ULTIMATEbros3 wire and 0.014 inch Conquest pro wire 9g. Finally the wire was advanced into true lumen. For the safety, we changed 0.014 inch Conquest pro wire 9g to the soft wire. A Route wire with Corsair Coronary Micro-Guide catheter was passed into the diagonal branch (Figure 1, Figure 2, Figure 3). Several sequential balloon dilatation with Sprinter legend 2.5*20mm was performed. After several pre-dilation, we deployed XIENCE Prime 3.5 * 28 mm and XIENCE 3.5 * 24 mm (Figure 4, Figure 5). The final angiogram showed well positioned and expanded stent with good distal run-off flow ( Movie 4, Movie 5). |
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