Slides TCTAP
[April 29] CTO LIVE_Asan Medical Center, Seoul, Korea: Case #1
- Operator : Nae-Hee Lee
1st Operator: Nae Hee Lee / 2nd Operator: Jon Suh
Brief Case Summary
A 66-year old male admitted for dyspnea on exertion started from 2 months ago. He had a previous history of failed PCI at mid LAD CTO lesions 12 years ago. After then, he have not visited the out-patient clinic.
His coronary risk factors were diabetes, hypertension, and ex-smoker.
Past Medical History
- Previous MI: N
- Previous CABG : N
- Previous PCI: N (failed)
- Other: permanent pacemaker implantation due to sick sinus syndrome (5 years ago)
history of cerebrovascular accident (6 years ago)
Nonvalvular atrial fibrillation on dabigatran
Demographic Characteristics
- Diabetes: Y
- Hypertension: Y
- Hyperlipidemia: N
- Smoking: Y (quit 20 years ago)
- Family History: -
- Age: 66
- Sex: Male
Clinical Presentation
Stable angina
Non-invasive Studies
Echocardiography
Akinesia of apical septum and inferior walls with mild LV dysfunction (LV EF 46%)
Treadmill test
Not done
Thallium SPECT
partially reversible large sized absent perfusion in apical to mid anterior and apical septal walls
Cardiac Catheterization Findings
- The left coronary angiogram showed chronic total occlusion of proximal to mid LAD.
- The right coronary angiogram showed mild CAD. (SYNTAX score 26.5)
Case Notes
Target Lesion(s)
Proximal to mid LAD
Adjunctive Medication
- ASA: Y
- LMWH: N
- Clopidogrel: N
- Heparin: N
- Nitrates: N
- IIb/IIIa: N
- Other: calcium channel antagonist, angiotensin receptor blocker, amiodarone, dabigatran, statin
CT findings - volume rendering image
CT findings - multiplanar reconstruction image
Teaching Points
- Antegrade approach (+/- IVUS-Guided Penetration technique)
His coronary risk factors were diabetes, hypertension, and ex-smoker.
- Previous MI: N
- Previous CABG : N
- Previous PCI: N (failed)
- Other: permanent pacemaker implantation due to sick sinus syndrome (5 years ago)
history of cerebrovascular accident (6 years ago)
Nonvalvular atrial fibrillation on dabigatran
- Diabetes: Y
- Hypertension: Y
- Hyperlipidemia: N
- Smoking: Y (quit 20 years ago)
- Family History: -
- Age: 66
- Sex: Male
Echocardiography
Akinesia of apical septum and inferior walls with mild LV dysfunction (LV EF 46%)Treadmill test
Not doneThallium SPECT
partially reversible large sized absent perfusion in apical to mid anterior and apical septal walls- The left coronary angiogram showed chronic total occlusion of proximal to mid LAD.
- The right coronary angiogram showed mild CAD. (SYNTAX score 26.5)
Target Lesion(s)
Proximal to mid LAD- ASA: Y
- LMWH: N
- Clopidogrel: N
- Heparin: N
- Nitrates: N
- IIb/IIIa: N
- Other: calcium channel antagonist, angiotensin receptor blocker, amiodarone, dabigatran, statin
- Antegrade approach (+/- IVUS-Guided Penetration technique)
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