Case

[April 25] CTO LIVE_Severance Hospital, Seoul, Korea: Case #6

- Operator : Byeong-Keuk Kim

1st Operator: Byeong-Keuk Kim / 2nd Operator: Jung-Hee Lee

Brief Case Summary

A 44-year-old man has CAD 1VD (dRCA) revealed by heart CT. We found hypokinetic myocardial wall motion on RCA territory by echocardiography and also positive findings of TMT.

Past Medical History

  • Previous MI: N
  • Previous CABG : N
  • Previous PCI: N
  • Other: Lt MCA infarction (s/p Lt proximal ICA stent insertion)

Demographic Characteristics

  • Diabetes: N
  • Hypertension: Y
  • Hyperlipidemia: Y
  • Smoking: N
  • Family History: N
  • Age: 44
  • Sex: Male

Clinical Presentation

Stable angina

Non-invasive Studies

Echocardiography

Moderate to severe hypokinesia, LVEF 49%

Treadmill test

Positive at stage III (max 13.4 METs)

Thallium SPECT

Not done

Cardiac Catheterization Findings

CTO at dRCA with visible island just distal to the proximal stump
Collateral flow from septal a to dRCA
Collateral flow from dLAD to LCx
CTO at dLCx

Case Notes

Target Lesion(s)

dRCA

Adjunctive Medication

  • ASA: Y
  • LMWH: N
  • Clopidogrel: N
  • Heparin: N
  • Nitrates: N
  • IIb/IIIa: N
  • Other: ticlopidine, carvediolol SR 16 mg, banidipine 5 mg, diltiazem SR 90 mg bid, atorvastatin 80 mg, trimetazidine 35 mg bid

Heart CT (2017.03.28)

CTO at dRCA
CTO at dLCx

Coronary angiography (2016.11.21)

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