Slides
Entrapment of Retrograde Wire in an Intervention of Chronic Total Occlusion
- Operator : Charles Chan
Entrapment of Retrograde Wire in an
Intervention of Chronic Total Occlusion |
- Operator: Charles Chan, MD |
Clinical Presentation and baseline angiography |
A 50 year old man presented with effort chest pain. He underwent stenting for a significant stenosis at the left circumflex artery (LCX) 6 months ago. Initial coronary angiogram showed a chronic total obstruction (CTO) of the previously stented LCX (Figure 1, Figure 2). Initial attempt in recannalisation the CTO was not successful as the wire exited into the false lumen. One month later, the patient was readmitted for a second attempt. |
Procedure |
After engaging of a 6F XB 3.5 guiding catheter,
a 0.014" Terumo Runthrough was maneuvered in the distal diagonal
branch through the collaterals into the obtuse marginal branch (retrograde
approach) (Figure
3). Using this wire as a marker, a Miracle 3 gm was then advanced
antegradely into the CTO lesion of LCX (Figure
4). The Miracle wire was successfully passed into the distal LCX with
a kissing wires technique (Figure
5, Figure
6). After then, sequential dilatations with a 2.0 mm balloon were
performed (Figure
7). Subsequent injections confirmed that the wire was in fact in the
true lumen (Figure
8). However, when the retrograde wire (Terumo Runthrough) was withdrawn,
it was not possible to retrieve it beyond the origin of the diagonal branch
(Figure
9). Therefore, dilatation of the ostium of the diagonal was done using
a 1.5 mm balloon (Figure
10). Further attempts to remove the wire resulted in the breakage
of the wire, of which the proximal end was left ouside the left coronary
ostium (Figure
11, Figure
12). Despite of the remained wire in the coronary artery, the procedure
was finished and the patient was discharged without any adverse event. |
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