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TCTAP C-097 Successful Percutaneous Coronary Intervention for Severe Three Vessel Disease Including Chronic Total Occlusion in the Patient with Lipton LII-B Single Coronary Artery
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
S205
Case Summary. Grafting a vessel leads to more aggressive progression of proximal native vessel disease. This sometimes leads to difficulties in wire crossing and device delivery, if PCI becomes warranted.Acute coronary syndromes in such patients rapidly progress to hemodynamic instability, warranting aggressive measures and portending worse outcomes. Rapid switching between antegrade and retrograde approaches should be expedited to restore flow and complete procedures promptly. TCTAP C-097 Successful Percutaneous Coronary Intervention for Severe Three Vessel Disease Including Chronic Total Occlusion in the Patient with Lipton LII-B Single Coronary Artery Naoki Makita1 Seichokai Futyu Hospital, Japan
1
[CLINICAL INFORMATION] Patient initials or identifier number. S.I. Relevant clinical history and physical exam. A 48-year-old male with a history of ex-smoker, diabetes mellitus, hypertension and dyslipidemia had been suffered from chest pain over a few days and transferred to our hospital, suspected acute coronary syndrome. Relevant test results prior to catheterization. His electrocardiogram revealed ST segment elevation in leads II, III, aVf, V1-5, and transthoracic echocardiography revealed asynergy of anteroseptal and inferior wall of the left ventricle. Relevant catheterization findings. Emergent coronary angiography (CAG) was performed and showed a single coronary artery and anomalous origin of right coronary artery from the left main coronary artery (LMCA). The occlusive lesion at the middle potion of right coronary artery (RCA) and severe stenosis were also seen at the middle potion of both left anterior descending artery (LAD) and circumflex coronary artery (LCX).
[INTERVENTIONAL MANAGEMENT] Procedural step. We did not performed further intervention and ended only emergency CAG, because the plasma level of myocardial enzyme was normal and his condition remained stable, and he did not have the chest pain at the time of rest. Multi-detector computerized tomography(MDCT) which was performed after CAG revealed the anomalous origin of RCA from the LMCA, and the RCA coursed between ascending aorta and pulmonary artery. This case was classified into the Lipton LII-B single coronary artery by those results. We recommended CABG to him, but he refused it. So we tried percutaneous coronary intervention(PCI) for three vessel lesions. Firstly, we tried PCI for chronic total occlusion(CTO) of RCA. We thought we could not get enough backup, therefore we decided to perform via right femoral artery using 8Fr guiding catheter(JL3.5(SH)) and 5Fr inner catheter with the mother and child system. The mother catheter was engaged to LCA and the inner catheter was advanced deep into near the RCA ostium. After a guidewire was inserted into the RCA, the tip of the child catheter was inserted slowly into the RCA along the guidewire. We could get enough backup by the system, so we succeeded in passage of the guidewire and stenting without any complication. After a few days, we performed PCI for LAD and LCX. CAG at one year later after the successful PCI showed no significant restenosis.
S206
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
Case Summary. PCI for single coronary artery is technically difficult because of difficulties associated with locating and cannulating the ostium, and the poor guiding catheter backup during the procedure. In the present case, using the inner catheter in the mother and child system was very useful and effective. To our knowledge, this is the first case report of PCI for severe three vessel disease including CTO in the patient with Lipton LII-B single coronary artery. TCTAP C-098 Strategy for Percutaneous Revascularization of Coronary Chronic Total Occlusion Jailed by Previously Deployed Stent Yoshiki Uehara1 1 Mito Brain Heart Center, Japan [CLINICAL INFORMATION] Patient initials or identifier number. H.B. Relevant clinical history and physical exam. The target lesion was mid LAD CTO jailed by a stent, which had been deployed 17 months before. PCI for the LAD CTO was attempted twice by another operator before the stent deployment, however they resulted in unsuccess. [INTERVENTIONAL MANAGEMENT] Procedural step. Approach: Bi-femoral approach Guiding catheters: 7Fr EBU3.75SH, 7Fr AL1SH Microcatheters: Corsair 150cm, Caravel 135cm, Crusade Guidewires: Sion Blue, Sion, Suoh, Gaia Second, Gaia Third, RG3 Balloons: Emerge 2.25mm, Raiden 2.5mm, DES; Resolute Integrity 2.5/26mm, 2.25/14mm IVUS: Opticross Because of reattempted procedure, retrograde approach was performed first. Using Sion and Suoh guidewire supported with Corsair and Caravel microcatheter, septal branch was negotiated and the guidewire and microcatheter were reached distal LAD. Next, the CTO was penetrated with Gaia Second and Gaia Third guidewire. Consequently, by utilizing deflection, Gaia Third could penetrate the CTO in a retrograde wire crossing manner. The Gaia Third and Corsair were advanced to antegrade guiding catheter. Then, externalization was established using RG3 guidewire. After predilation, two DESs were deployed to the LAD, and postdilation and KBT was done.
S205
Case Summary. Grafting a vessel leads to more aggressive progression of proximal native vessel disease. This sometimes leads to difficulties in wire crossing and device delivery, if PCI becomes warranted.Acute coronary syndromes in such patients rapidly progress to hemodynamic instability, warranting aggressive measures and portending worse outcomes. Rapid switching between antegrade and retrograde approaches should be expedited to restore flow and complete procedures promptly. TCTAP C-097 Successful Percutaneous Coronary Intervention for Severe Three Vessel Disease Including Chronic Total Occlusion in the Patient with Lipton LII-B Single Coronary Artery Naoki Makita1 Seichokai Futyu Hospital, Japan
1
[CLINICAL INFORMATION] Patient initials or identifier number. S.I. Relevant clinical history and physical exam. A 48-year-old male with a history of ex-smoker, diabetes mellitus, hypertension and dyslipidemia had been suffered from chest pain over a few days and transferred to our hospital, suspected acute coronary syndrome. Relevant test results prior to catheterization. His electrocardiogram revealed ST segment elevation in leads II, III, aVf, V1-5, and transthoracic echocardiography revealed asynergy of anteroseptal and inferior wall of the left ventricle. Relevant catheterization findings. Emergent coronary angiography (CAG) was performed and showed a single coronary artery and anomalous origin of right coronary artery from the left main coronary artery (LMCA). The occlusive lesion at the middle potion of right coronary artery (RCA) and severe stenosis were also seen at the middle potion of both left anterior descending artery (LAD) and circumflex coronary artery (LCX).
[INTERVENTIONAL MANAGEMENT] Procedural step. We did not performed further intervention and ended only emergency CAG, because the plasma level of myocardial enzyme was normal and his condition remained stable, and he did not have the chest pain at the time of rest. Multi-detector computerized tomography(MDCT) which was performed after CAG revealed the anomalous origin of RCA from the LMCA, and the RCA coursed between ascending aorta and pulmonary artery. This case was classified into the Lipton LII-B single coronary artery by those results. We recommended CABG to him, but he refused it. So we tried percutaneous coronary intervention(PCI) for three vessel lesions. Firstly, we tried PCI for chronic total occlusion(CTO) of RCA. We thought we could not get enough backup, therefore we decided to perform via right femoral artery using 8Fr guiding catheter(JL3.5(SH)) and 5Fr inner catheter with the mother and child system. The mother catheter was engaged to LCA and the inner catheter was advanced deep into near the RCA ostium. After a guidewire was inserted into the RCA, the tip of the child catheter was inserted slowly into the RCA along the guidewire. We could get enough backup by the system, so we succeeded in passage of the guidewire and stenting without any complication. After a few days, we performed PCI for LAD and LCX. CAG at one year later after the successful PCI showed no significant restenosis.
S206
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
Case Summary. PCI for single coronary artery is technically difficult because of difficulties associated with locating and cannulating the ostium, and the poor guiding catheter backup during the procedure. In the present case, using the inner catheter in the mother and child system was very useful and effective. To our knowledge, this is the first case report of PCI for severe three vessel disease including CTO in the patient with Lipton LII-B single coronary artery. TCTAP C-098 Strategy for Percutaneous Revascularization of Coronary Chronic Total Occlusion Jailed by Previously Deployed Stent Yoshiki Uehara1 1 Mito Brain Heart Center, Japan [CLINICAL INFORMATION] Patient initials or identifier number. H.B. Relevant clinical history and physical exam. The target lesion was mid LAD CTO jailed by a stent, which had been deployed 17 months before. PCI for the LAD CTO was attempted twice by another operator before the stent deployment, however they resulted in unsuccess. [INTERVENTIONAL MANAGEMENT] Procedural step. Approach: Bi-femoral approach Guiding catheters: 7Fr EBU3.75SH, 7Fr AL1SH Microcatheters: Corsair 150cm, Caravel 135cm, Crusade Guidewires: Sion Blue, Sion, Suoh, Gaia Second, Gaia Third, RG3 Balloons: Emerge 2.25mm, Raiden 2.5mm, DES; Resolute Integrity 2.5/26mm, 2.25/14mm IVUS: Opticross Because of reattempted procedure, retrograde approach was performed first. Using Sion and Suoh guidewire supported with Corsair and Caravel microcatheter, septal branch was negotiated and the guidewire and microcatheter were reached distal LAD. Next, the CTO was penetrated with Gaia Second and Gaia Third guidewire. Consequently, by utilizing deflection, Gaia Third could penetrate the CTO in a retrograde wire crossing manner. The Gaia Third and Corsair were advanced to antegrade guiding catheter. Then, externalization was established using RG3 guidewire. After predilation, two DESs were deployed to the LAD, and postdilation and KBT was done.