Recanalization of Chronic Totally Occluded Left Anterior Descending Artery with "Parallel Wire Technique"
- Operator: Takahiko Suzuki, MD
Clinical presentation
A 61-year old man was admitted due to chest pain for 10 years. His coronary risk factors were diabetes and hypertension. Electrocardiography was normal. Echocardiography showed akinesia of posterior wall with mild left ventricular dysfunction (LVEF=50%).
Baseline coronary angiogram
1. Right coronary angiogram showed significant narrowing of PDA branch and grade 3 collateral flow to proximal LAD (Figure
1).
2. Left coronary angiogram revealed total occlusion of proximal to mid LAD with bridge collaterals (Figure 2, Figure 3).
Procedure
Left coronary artery was engaged with 8F EBU with 3.5 cm curve1. At first, antegrade wiring was attempted with a 0.014 inch Fielder guidewire (Asahi Intecc, Japan) (Figure 4). A 0.014 inch Miracle 3 guidewire (Neo¡¯s, Asahi, Japan) with Finecross microcatheter was advanced to the lesion (Figure 5). And then, a second 0.014 inch Miracle 12 guidewire (Neo¡¯s, Asahi, Japan) with Finecross microcatheter was advanced to the lesion (Figure 6, Figure 7). By parallel wire technique, a Miracle 12 guidewire could be advanced forward and began to penetrate toward the correct direction (Figure 8, Figure 9). After changing to 0.014 inch BMW guidewire, predilation was performed with a 1.5 X 20 mm Ryujin balloon by 16 atm (1.72 mm) (Figure 10). Then, additional predilation was performed with a 3.0 X 20 mm Ryujijn balloon by from 8 atm (3.09 mm) to 13 atm (3.25 mm) (Figure 11, Figure 12). After predilation, a 3.5 X 23 mm Cypher stent was positioned at proximal to mid LAD and deployed by 15 atm (3.69 mm) and a 3.0 ¡¿ 33 mm Cypher stent at mid to distal LAD by 18 atm (3.26 mm) (Figure 13, Figure 14). Additional balloon of proximal to mid LAD stent was done with a stent balloon at 22 atm (3.88 mm). Final angiogram showed a well-expanded stents (Figure 15, Figure 16).
