Slides
Antegrade approach to pLAD CTO
- Operator : Nae-Hee Lee
| Antegrade approach to pLAD CTO |
| - Operator: Nae Hee Lee, MD |
| Case Presentation |
| A 62-year-old gentleman was admitted with effort chest pain for 2 years. His coronary risk factor was hyperlipidemia. The echocardiography showed normal LV systolic function without RWMA (EF=60%). TMT was positive at stage 3 and thallium scan showed partially reversible large sized perfusion defect at LAD territory. |
| Baseline coronary angiogram |
1. The left coronary angiogram showed total occlusion at pLAD and tight stenosis at dLCX( Movie 1, Movie 2).2. The right coronary angiogram was near normal. |
| Procedure |
| An 8 Fr sheath was inserted through right femoral artery, and the left coronary artery ostium was engaged with 7 Fr AL 2 catheter with side hole. Initially, we tried to insert combination of Fielder FC 0.014 inch guidewire and a Finecross® 0.014-inch 130cm microcatheter into LAD. We failed several times for guidewire to pass into the LAD. Finally, by using the Crusade microcatheter, 0.014 inch Conquest pro guidewire was inserted LAD(Figure 1). Proximal LAD was predilated with 1.25 x 15mm Sprinter legend balloon and guidewire was exchanged to 0.014 inch Fielder FC(Figure 2). And then, proximal to middle LAD was predilated with Everast 2.0 x 15mm balloon. To evaluate LAD lesion, we did IVUS. By IVUS, the guidewire was inserted in false lumen, so we decide to retrograde approach. A Fielder FC 0.014 inch -180cm with a Corsair® 0.014 inch 2.6 Fr – 150cm microcatheter was approached to retrograde pathway to LAD(Figure 3). The angiogram of retrograde pathway showed about TIMI 1-2 flow in LAD( Movie 3, Movie 4). We decided staged PCI for LCX lesion. |
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