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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
TCTAP C-063 IVUS and Crusade MC Assisted Parallel Wiring Technique for a Case with LCX CTO Wei Chieh Huang1 Taipei Veterans General Hospital, Taiwan
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[CLINICAL INFORMATION] Patient initials or identifier number. 42257807 Relevant clinical history and physical exam. The 66 patient had history of DM and CAD. This time he suffered from chest tightness and he consulted our hospital. Thallium scan showed ischemia. Therefore he was admitted to receive scheduled PCI.
Relevant test results prior to catheterization. Thallium scan showed positive finding of ischemia. Relevant catheterization findings. CAG was done via RFA and showed CAD with LMþTVD s/pPCI. (LM: -M: 70% stenosis; LAD: -Os: 70% stenosis, -M to -D: instent patent;LCX: -M: total occlusion; RCA: -M to -D: instent patent).
Case Summary. 1. In perfect priorPCI to donor vessel will increased the difficulties of retrograde device (MCor CART balloon) manipulation. 2. Even retrograde wire enter antegrade GC after reverse CART, microcatheter(corsail) is still possiblly stuck by cacified CTO distal cap. 3. Tranditional CART still play important role to open distal CTO cap tofacilitate retrograde MC enter GC to achieve further externalization.
[INTERVENTIONAL MANAGEMENT] Procedural step. For LCX lesion, we engaged LMCA with XB 3.5/7GC. A Fielder FC GW with support of Sprinter 1.25x6mm OTW was tried to cross the CTO lesion successfully after several trials. IVUS showed we entered the false lumen in the beginning. After the confirmation of the entry point from true to false, we introduced the Provia 12 GW with support of Crusade MC and punctured into the true lumen successfully (parallel wire technique). A Sprinter 1.25x6mm OTW was inflated over LCX-M to -OM with pressure up to 14 barr followed by Sprinter Legend 2.5x15mm BC with pressure up to 8 barr. Due to CTO lesion and post POBA dissection type B, a Promus Premier 2.5x38mm DES was
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
deployed over LCX-M to -OM with pressure up to 12 barr. IVUS showed well apposition of stent. The final result of LCX was good with TIMI flow 3. As for LM to LAD-Os lesion, IVUS showed minal luminal area was 5.1mm2. A Sprinter Legend 2.5x15mm BC was inflated over LM to LAD-Os with pressure up to 16 barr. Due to ostial lesion, a Biomatrix flex 3.5x14mm DES was deployed over LM to LAD-Os with pressure up to 12 barr. KBT was done with Sprinter legend 2.5x15mm BC in LM to L CX-Os with stent balloon 3.5x14mm BC in LM to LAD-Os with pressure up to 10 barr. A stent balloon 3.5x14mm BC was inflated over LAD-M previous instent area with pressure up to 16 barr. The final result of LM and LAD was good with TIMI flow 3. The patient tolerated the whole procedure well and was sent to CCU for further care.
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Case Summary. IVUS play an important role in the treatment of CTO with poor collaterals and parallel wiring technique assisted By IVUS/ Crusade MC is help for ante grade approach. TCTAP C-064 Complete Revascularization of Triple Vessel Disease Including Two Chronic Total Occlusions with Rotational Atherectomy and Retrograde Techniques Hidetsugu Sakai1 Kushiro City General Hospital, Japan
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[CLINICAL INFORMATION] Patient initials or identifier number. IY Relevant clinical history and physical exam. An 80 year-old lady, who took several antihypertensive gents, complained of severe dyspnea was admitted. At that time, she had never experienced angina. We auscultated moist rale and found pitting edema. And X-ray showed pulmonary congestion. Relevant test results prior to catheterization. Electrocardiography showed neither abnormal Q waves nor ST-T segment abnormalities. Moreover, echocardiography did not show any reduced wall motions and her left ventricular ejection fraction was 62.0%. Relevant catheterization findings. Coronary angiography was performed after she recovered from congestive heart failure, and it showed a severely calcified stenosis at middle segment of left anterior descending artery (LAD). Moreover, two chronic total occlusions at middle segment of left circumflex artery (LCX) and distal segment of right coronary artery (RCA) were also revealed. LAD supplied collaterals to RCA via septal branches, and there was a well developed epicardial channel from proximal RCA to LCX.