Slides TCTAP
[April 29] CTO LIVE_Asan Medical Center, Seoul, Korea: Case #2
- Operator : Yasushi Asakura
1st Operator: Yasushi Asakura / 2nd Operator: Hyuck Jun Yoon
Brief Case Summary
A 61 year-old male admitted for dyspnea on exertion aggravated from 1 month ago and ECG abnormalities (Q in inferior leads).
His coronary risk factors were hyperlipidemia and ex-smoker.
Past Medical History
- Previous MI: N
- Previous CABG : N
- Previous PCI: N
- Other: None
Demographic Characteristics
- Diabetes: N
- Hypertension: N
- Hyperlipidemia: Y
- Smoking: Y (quit 10 months ago)
- Family History: N
- Age: 61
- Sex: Male
Clinical Presentation
Stable angina
Non-invasive Studies
Echocardiography
Akinesia of inferoposterior walls with mild LV dysfunction (LV EF 51%)
Treadmill test
Not done
Thallium SPECT
Partially reversible large sized severely decreased perfusion in mid to basal inferoseptal, inferior walls
Cardiac Catheterization Findings
- The left coronary angiogram showed normal findings and epicardial collateral flows from LA branch and LCX to PL branch, and from septal branches to PDA.
- The right coronary angiogram showed chronic total occlusion at proximal RCA. (SYNTAX score 16)
Case Notes
Target Lesion(s)
Proximal RCA
Adjunctive Medication
- ASA: Y
- LMWH: N
- Clopidogrel: Y
- Heparin: N
- Nitrates: N
- IIb/IIIa: N
- Other: beta blocker, calcium channel antagonist, angiotensin receptor blocker, statin
Coronary angiography
Teaching Points
- Antegrade or retrograde approach for RCA CTO
His coronary risk factors were hyperlipidemia and ex-smoker.
- Previous MI: N
- Previous CABG : N
- Previous PCI: N
- Other: None
- Diabetes: N
- Hypertension: N
- Hyperlipidemia: Y
- Smoking: Y (quit 10 months ago)
- Family History: N
- Age: 61
- Sex: Male
Echocardiography
Akinesia of inferoposterior walls with mild LV dysfunction (LV EF 51%)Treadmill test
Not doneThallium SPECT
Partially reversible large sized severely decreased perfusion in mid to basal inferoseptal, inferior walls- The left coronary angiogram showed normal findings and epicardial collateral flows from LA branch and LCX to PL branch, and from septal branches to PDA.
- The right coronary angiogram showed chronic total occlusion at proximal RCA. (SYNTAX score 16)
Target Lesion(s)
Proximal RCA- ASA: Y
- LMWH: N
- Clopidogrel: Y
- Heparin: N
- Nitrates: N
- IIb/IIIa: N
- Other: beta blocker, calcium channel antagonist, angiotensin receptor blocker, statin
- Antegrade or retrograde approach for RCA CTO
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