Slides
Retrograde Approach for Proximal RCA ISR CTO Lesion Through the Thread-like Septal Branch
- Operator : Seung-Whan Lee
Retrograde Approach for Proximal RCA ISR CTO Lesion Through the Thread-like Septal Branch |
- Operator: Seung-Whan Lee, MD |
Case Presentation |
A 57-year-old gentleman presented with effort chest pain. Fifteen years ago, he underwent PCI at proximal LAD (NIR 2.5¡¿25mm) and proximal RCA (J&J 4.0¡¿17mm) in our hospital. His coronary risk factors were hypertension and ex-smoker. The physical examination was unremarkable. The ECG and cardiac enzymes were normal. The transthoracic echocardiography showed moderately decreased LV systolic function (EF=40%) with regional wall motion abnormality of LAD and RCA territory. The exercise treadmill test was negative. |
Baseline Coronary Angiography |
Procedure |
A 7F sheath was inserted through right femoral artery, and the left coronary artery was engaged with a 7F JL5 catheter. 0.014-inch NEO¡¯s (Soft) wire with a FINECROSS 0.014 inch 1.8Fr-130cm microcatheter was inserted into the LCX. The guidewire was changed to BMW(powerturn) 0.014 inch-300cm. After that, 0.014-inch NEO¡¯s (Soft) wire was inserted into the LAD (Figure 1). Distal LCX was predilated with 3.0 x 15mm Pantera LEO balloon. We dilated mid LAD using 3.0 x 15mm Pantera LEO balloon for anchoring. A XIENCE Xpedition 3.5 x 38 mm stent was successfully deployed at dLCX (Figure 2). After that, we predilated with a Flextome Cutting balloon 3.0 x 10mm and dilated with a DEB, SeQuent Please, 3.0 x 26mm at mid LAD ISR lesion (Figure 3). 014-inch NEO¡¯s (SION) wire with a Corsair 0.014 inch 2.6Fr-150cm microcatheter was inserted from LAD to RCA by retrograde approach (Figure 4). And guidewire was changed to Fielder XT R 0.014 inch-180cm. Right coronary artery was positioned with 7Fr JR4 guiding by left femoral artery. The guidewire was inserted from the left guiding catheter to the right guiding catheter and it formed a wire loop (retrograde wire externalization) ( Movie 4). From the guidewire tip outside the right sheath, predilatation with Lacrosse 2.0 x 15mm, Pantera LEO 3.0 x 15mm and Flextome Cutting balloon 3.0 x 10mm was performed proximal RCA. We dilatated mid RCA with a DEB, SeQuent Please, 3.0 x 30mm (Figure 5). Final angiogram showed that the procedure was successful ( Movie 5). |
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