Anterograde Approach for LCA CTO Lesion
- Operator : Kenya Nasu
|Anterograde Approach for LCA CTO Lesion|
|- Operator: Kenya Nasu, MD|
|A 61-year-old male patient was admitted for abnormal electrocardiogram and echocardiogram. He had no effort chest pain and dyspnea on exertion. His coronary risk factor was current-smoking, hypertension and diabetes mellitus. His echocardiogram showed mild LV dysfunction (EF 50%) and RCA/LAD territory regional wall motion abnormality (basal inferior, mid posterior, mid anterior and apical wall). Thallium SPECT showed reversible large decreased perfusion in LAD territory.|
|Baseline Coronary Angiogram|
Right coronary artery was engaged with a 7 Fr AR 2 guiding catheter and left coronary artery was positioned with an 7 Fr EBU 3.5 guiding catheter through the bi-femoral approach. After anchoring balloon (Euphora 2.0 x 20 mm) at diagonal artery, we tried to pass the CTO lesion by anterograde approach using Gaia next 1 wire with Caravel 135cm microcatheter ( Movie 3). Lastly, we tried to pass the CTO lesion by anterograde approach with Gaia next 2 wire. And then, we successfully pass wire into RCA CTO lesion ( Movie 4). After advancement of Caravel microcatheter, we changed Gaia next 2 wire to Sion blue wire and performed several balloon dilatations at proximal to middle LAD using Euphora 2.0 x 20 mm and FLYDO 2.5 x 20 mm ( Movie 5). After predilatations, we deployed one Resolute Onyx stent (3.5 x34mm proximal to mid LAD, Movie 6). After stenting, we checked stent under-expansion by IVUS (Figure 1). We inflated Sapphire NC 4.0 x 10mm up to 24atm (4.4mm) at proximal LAD ( Movie 7). The final IVUS showed well appositioned stent at proximal to mid LAD (Figure 2). The final angiogram showed successful revascularization at LAD CTO lesion ( Movie 9, Movie 10).
RCA view showing retrograde filling of LAD: Movie 11
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