Case

[April 29] CTO LIVE_Asan Medical Center, Seoul, Korea: Case #2

- Operator : Yasushi Asakura

1st Operator: Yasushi Asakura / 2nd Operator: Hyuck Jun Yoon

Brief Case Summary

A 61 year-old male admitted for dyspnea on exertion aggravated from 1 month ago and ECG abnormalities (Q in inferior leads).
His coronary risk factors were hyperlipidemia and ex-smoker.

Past Medical History

  • Previous MI: N
  • Previous CABG : N
  • Previous PCI: N
  • Other: None

Demographic Characteristics

  • Diabetes: N
  • Hypertension: N
  • Hyperlipidemia: Y
  • Smoking: Y (quit 10 months ago)
  • Family History: N
  • Age: 61
  • Sex: Male

Clinical Presentation

Stable angina

Non-invasive Studies

Echocardiography

Akinesia of inferoposterior walls with mild LV dysfunction (LV EF 51%)

Treadmill test

Not done

Thallium SPECT

Partially reversible large sized severely decreased perfusion in mid to basal inferoseptal, inferior walls

Cardiac Catheterization Findings

  • The left coronary angiogram showed normal findings and epicardial collateral flows from LA branch and LCX to PL branch, and from septal branches to PDA.
  • The right coronary angiogram showed chronic total occlusion at proximal RCA. (SYNTAX score 16)

Case Notes

Target Lesion(s)

Proximal RCA

Adjunctive Medication

  • ASA: Y
  • LMWH: N
  • Clopidogrel: Y
  • Heparin: N
  • Nitrates: N
  • IIb/IIIa: N
  • Other: beta blocker, calcium channel antagonist, angiotensin receptor blocker, statin

Coronary angiography

Teaching Points

  • Antegrade or retrograde approach for RCA CTO

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