Case

Antegrade Approach for Proximal LAD CTO Lesion

- Operator : Etsuo Tsuchikane

Antegrade Approach for Proximal LAD CTO Lesion
- Operator: Etsuo Tsuchikane, MD
Case Presentation
A 54 year-old gentleman was referred for CTO intervention. Several months ago, he was found to have coronary artery disease after general health check-up. He complained of exertional chest pain . His coronary risk factors were ex-smoking, and hyperlipidemia. The physical examination was normal. The ECG and cardiac enzymes were unremarkable. The echocardiography showed normal LV function without RWMA. Based on his typical chest pain, we performed coronary angiography.
Baseline Coronary Angiography
1. The left coronary angiogram showed total occlusion at pLAD ( Movie 1, Movie 2).
2. The right coronary angiogram did not show any significant stenosis ( Movie 3).
Procedure
Right coronary artery was cannulated with a 5 Fr IM diagnostic catheter and left coronary artery was positioned with a 7 Fr XB 3.5 SH guiding catheter through the bi-femoral approach. Initially, we tried antegrade approach at pLAD by using a 0.014 inch BMW wire with Corsair 0.014 inch 2.6 Fr 150cm microcatheter. After negotiation, we succeeded in the engagement of wire into dLAD with NEO¡¯s Gaia 0.014 inch - 180 cm wire, and predilatation was performed with Maverick 2.0 x 20mm balloon at pLAD (Figure 1). And then we engaged Fielder FC wire with double lumen microcatheter ? into first diagonal branch with total occlusion. Additional predilatation was performed with Maverick 2.5 x 20mm balloon at first diagonal branch (Figure 2). PROMUS Element stent 3.0 x 38mm and 3.5 x 12mm were implanted from mid LAD to distal LM (Figure 3, Figure 4, Figure 5). Final angiogram showed that the procedure was successful ( Movie 4, Movie 5).

Comments

  • Bing Liu 2013-07-27 Nice results£¡If the BRS was available, the patient will get a full new LM-LAD coronary. For the CTO lesion treatment, the antegrade strategy should always be the first choice.And if you failed in first time you should try again one month late! Retrograde strategy more like a show, not reasonable for poor longterm outcome!
  • Joao Alexandre Farjalla 2013-08-15 Well indicated procedure and a nice result. Congratulations.

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