Case

[April 29] CTO LIVE_Asan Medical Center, Seoul, Korea: Case #1

- Operator : Nae-Hee Lee

1st Operator: Nae Hee Lee / 2nd Operator: Jon Suh

Brief Case Summary

A 66-year old male admitted for dyspnea on exertion started from 2 months ago. He had a previous history of failed PCI at mid LAD CTO lesions 12 years ago. After then, he have not visited the out-patient clinic.
His coronary risk factors were diabetes, hypertension, and ex-smoker.

Past Medical History

  • Previous MI: N
  • Previous CABG : N
  • Previous PCI: N (failed)
  • Other: permanent pacemaker implantation due to sick sinus syndrome (5 years ago)
    history of cerebrovascular accident (6 years ago)
    Nonvalvular atrial fibrillation on dabigatran

Demographic Characteristics

  • Diabetes: Y
  • Hypertension: Y
  • Hyperlipidemia: N
  • Smoking: Y (quit 20 years ago)
  • Family History: -
  • Age: 66
  • Sex: Male

Clinical Presentation

Stable angina

Non-invasive Studies

Echocardiography

Akinesia of apical septum and inferior walls with mild LV dysfunction (LV EF 46%)

Treadmill test

Not done

Thallium SPECT

partially reversible large sized absent perfusion in apical to mid anterior and apical septal walls

Cardiac Catheterization Findings

  • The left coronary angiogram showed chronic total occlusion of proximal to mid LAD.
  • The right coronary angiogram showed mild CAD. (SYNTAX score 26.5)

Case Notes

Target Lesion(s)

Proximal to mid LAD

Adjunctive Medication

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

CT findings - volume rendering image

CT findings - multiplanar reconstruction image

Teaching Points

  • Antegrade approach (+/- IVUS-Guided Penetration technique)

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