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TCTAP C-100 A Successful Treated Coronary Perforation Case with the LAD Chronic Total Occluded
S208
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
Case Summary. We experienced a CTO case of coronary thrombosis during the complex CTO procedure with step by step retrograde approach. The correct ACT measurement and the maintenance of ACT value were needed especially in the complex CTO PCI. TCTAP C-100 A Successful Treated Coronary Perforation Case with the LAD Chronic Total Occluded Zheng Ji1 Tangshan Gongren Hospital, China
Relevant test results prior to catheterization. [Laboratory Test] - Fasting blood glucose: 12.6 mmol/L; - NT-pro BNP:1160ng/L; - Blood fat, Routine blood test, Routine urine test, Myocardial enzymes, Renal function,Electrolyte were normal.
1
[CLINICAL INFORMATION] Patient initials or identifier number. G Z Relevant clinical history and physical exam. - Male, 51 years - Date of Admission: 7/15/2015,16:58 - Complaints: paroxysmal chest pain, chest stuffy, short of breath for 15 years, aggravating for 10 day Hypertension last for 5 years, the highest blood pressure was 160/ 110mmHg,without regular medication. Diabetes mellitus last for 10 years, with oral medicine, glucose was not controlledwell. Smoking for 30 years, 10 cigarettes every day. T 36.5 C, P 62/min, R 18/min, BP 100/60mmHg No abnormal breath sound was heard. No wheezes. No rales. No bulge and no abnormal impulse or thrills in precordial area. No pericardialfriction sound. Border of the heart was normal. Heart sounds were strong and nosplitting. Rate 62/min. Cardiac rhythm was regular. No pathological murmurs. Abdominal wall was Flat and soft. No bulge or depression. No abdominal wallvaricosis. Gastralintestinal type or peristalses were not seen. - ECG: ST in II、III、avF、V1wV6 elevated 0.1-0.3mv,T wave flatted or inverted.
[Diagnoses] -
Subacute anterior myocardial infarction Coronary atherosclerotic heart disease Old inferior myocardial infarction Hypertension grade 3 Type 2 diabetes mellitus [CAG instruments]
- Catheter: 5FTIG - Route: right radial artery. [CAG instruments] - Catheter: 5FTIG - Route: right radial artery. Relevant catheterization findings. [Results of coronary angiography] -
Terminus of LM was 50% stenosis, Proximal of LAD was total occluded, Ostial of LCX was 90% stenosis, Proximal of RCA was total occluded, Collateral circulation between LCX to RCA.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
S209
[Vital Signs] Complaint: chest stuffy, short of breath and palpitation; Temperature: 36.5 C; Pulse: 90/min; Respiratory: 25/min; Blood pressure: 60/46mmHg; Echocardiogram: middle amount of pericardial effusion. We decided to do Pericardiocentesis. [Deal with coronary artery perforation] Used Sprinter 1.25*15mm balloon dilatation to close down the breach. Used protamine to neutralizing heparin. Used gelfoam particles by micro catheter to close down the breach. Pericardiocentesis is a simple, safe and effective acute cardiac tamponade. [Vital signs stable] Temperature: 36.5 C; Pulse: 75/min; Respiratory: 18/min; Blood pressure: 125/75mmHg. Patient felt better.
[INTERVENTIONAL MANAGEMENT] Procedural step. - Catheter: 6FEBU3.5 - Wire: BMW、Pilot50、Fielder FC、Miracle6、DOC - Balloon: Sprinter 1.25/15mm - Micro catheter: Finecross 1. BMW guildwire arrived to distal of LCX 2. Pilot50 and Fielder FC couldn’t pass through the occluded lesion, used Finecross 3. micro catheter. 4. Miracle 6 passed through the occluded lesion by the micro catheter 5. We found contrast medium exosmose 6. Used Sprinter 1.25*15mm balloon dilatation to close down the breach. 7. Used gel foam particles by micro catheter to close down the breach 8. There was no contrast medium exosmose.
S210
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
TCTAP C-101 Successful Recanalization of Very Long Duration Chronic Total Occlusion in Right Coronary Artery by Using the Retrograde Approach via Occluded Saphenous Vein Graft Yasushi Ino,1 Takashi Kubo,1 Yosuke Katayama,1 Yoshiki Matsuo,1 Hironori Kitabata,1 Yasunori Yamamoto,1 Takeyoshi Kameyama,1 Takashi Yamano,1 Tomoyuki Yamaguchi,1 Makoto Orii,1 Hiroshi Aoki,1 Atsushi Tanaka,1 Takeshi Hozumi,1 Takashi Akasaka1 1 Wakayama Medical University, Japan [CLINICAL INFORMATION] Patient initials or identifier number. N.T Relevant clinical history and physical exam. A 70’s-yearold man with hypertension and dyslipidemia underwent coronary angiography (CAG)due to unstable angina 14 years ago. CAG showed severe triple vessel disease. Heunderwent coronary aorta bypass grafting (CABG) (left internal mammary artery(IMA) – left anterior descending artery (LAD), saphenous vein graft (SVG) – diagonal branch, SVG -posterior descending artery (PD)) and had all graft patency on follow-up CAG.He had a good clinical course after CABG. Relevant test results prior to catheterization. He was carried to ourhospital because of severe rest chest pain. His general physical examination onadmission revealed no abnormal findings. His 12-lead ECG demonstrated first degree atrioventricular (AV) block and ST-segment elevation in II, III, and aVF leads. He admitted due tothe diagnosis of inferior ST elevation myocardial infarction (STEMI). Relevant catheterization findings. Emergent CAG revealed total occlusionin the proximal native RCA and proximal portion of SVG to PD with fillingdefect. We performed primary PCI including aspiration thrombectomy for SVG toPD. However, we could not obtain the recanalization of occluded SVG because ofmassive thrombus and provided this patient with conservative therapy. 9 days later, monitor ECGrevealed advanced AV block. We decided attempting the recanalization of chronic total occlusion (CTO) of native RCA.
Case Summary. We advised the patient to do CABG, but he chose medication. Aspirin 100mg, oral daily Brilinta 90mg, oral two times a day Lipitor 20mg, oral daily Betaloc12.5mg, oral two times a day Trimedazidine20mg, oral three times a day Esomeprazole 20mg, oral daily
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
Case Summary. We experienced a CTO case of coronary thrombosis during the complex CTO procedure with step by step retrograde approach. The correct ACT measurement and the maintenance of ACT value were needed especially in the complex CTO PCI. TCTAP C-100 A Successful Treated Coronary Perforation Case with the LAD Chronic Total Occluded Zheng Ji1 Tangshan Gongren Hospital, China
Relevant test results prior to catheterization. [Laboratory Test] - Fasting blood glucose: 12.6 mmol/L; - NT-pro BNP:1160ng/L; - Blood fat, Routine blood test, Routine urine test, Myocardial enzymes, Renal function,Electrolyte were normal.
1
[CLINICAL INFORMATION] Patient initials or identifier number. G Z Relevant clinical history and physical exam. - Male, 51 years - Date of Admission: 7/15/2015,16:58 - Complaints: paroxysmal chest pain, chest stuffy, short of breath for 15 years, aggravating for 10 day Hypertension last for 5 years, the highest blood pressure was 160/ 110mmHg,without regular medication. Diabetes mellitus last for 10 years, with oral medicine, glucose was not controlledwell. Smoking for 30 years, 10 cigarettes every day. T 36.5 C, P 62/min, R 18/min, BP 100/60mmHg No abnormal breath sound was heard. No wheezes. No rales. No bulge and no abnormal impulse or thrills in precordial area. No pericardialfriction sound. Border of the heart was normal. Heart sounds were strong and nosplitting. Rate 62/min. Cardiac rhythm was regular. No pathological murmurs. Abdominal wall was Flat and soft. No bulge or depression. No abdominal wallvaricosis. Gastralintestinal type or peristalses were not seen. - ECG: ST in II、III、avF、V1wV6 elevated 0.1-0.3mv,T wave flatted or inverted.
[Diagnoses] -
Subacute anterior myocardial infarction Coronary atherosclerotic heart disease Old inferior myocardial infarction Hypertension grade 3 Type 2 diabetes mellitus [CAG instruments]
- Catheter: 5FTIG - Route: right radial artery. [CAG instruments] - Catheter: 5FTIG - Route: right radial artery. Relevant catheterization findings. [Results of coronary angiography] -
Terminus of LM was 50% stenosis, Proximal of LAD was total occluded, Ostial of LCX was 90% stenosis, Proximal of RCA was total occluded, Collateral circulation between LCX to RCA.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
S209
[Vital Signs] Complaint: chest stuffy, short of breath and palpitation; Temperature: 36.5 C; Pulse: 90/min; Respiratory: 25/min; Blood pressure: 60/46mmHg; Echocardiogram: middle amount of pericardial effusion. We decided to do Pericardiocentesis. [Deal with coronary artery perforation] Used Sprinter 1.25*15mm balloon dilatation to close down the breach. Used protamine to neutralizing heparin. Used gelfoam particles by micro catheter to close down the breach. Pericardiocentesis is a simple, safe and effective acute cardiac tamponade. [Vital signs stable] Temperature: 36.5 C; Pulse: 75/min; Respiratory: 18/min; Blood pressure: 125/75mmHg. Patient felt better.
[INTERVENTIONAL MANAGEMENT] Procedural step. - Catheter: 6FEBU3.5 - Wire: BMW、Pilot50、Fielder FC、Miracle6、DOC - Balloon: Sprinter 1.25/15mm - Micro catheter: Finecross 1. BMW guildwire arrived to distal of LCX 2. Pilot50 and Fielder FC couldn’t pass through the occluded lesion, used Finecross 3. micro catheter. 4. Miracle 6 passed through the occluded lesion by the micro catheter 5. We found contrast medium exosmose 6. Used Sprinter 1.25*15mm balloon dilatation to close down the breach. 7. Used gel foam particles by micro catheter to close down the breach 8. There was no contrast medium exosmose.
S210
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
TCTAP C-101 Successful Recanalization of Very Long Duration Chronic Total Occlusion in Right Coronary Artery by Using the Retrograde Approach via Occluded Saphenous Vein Graft Yasushi Ino,1 Takashi Kubo,1 Yosuke Katayama,1 Yoshiki Matsuo,1 Hironori Kitabata,1 Yasunori Yamamoto,1 Takeyoshi Kameyama,1 Takashi Yamano,1 Tomoyuki Yamaguchi,1 Makoto Orii,1 Hiroshi Aoki,1 Atsushi Tanaka,1 Takeshi Hozumi,1 Takashi Akasaka1 1 Wakayama Medical University, Japan [CLINICAL INFORMATION] Patient initials or identifier number. N.T Relevant clinical history and physical exam. A 70’s-yearold man with hypertension and dyslipidemia underwent coronary angiography (CAG)due to unstable angina 14 years ago. CAG showed severe triple vessel disease. Heunderwent coronary aorta bypass grafting (CABG) (left internal mammary artery(IMA) – left anterior descending artery (LAD), saphenous vein graft (SVG) – diagonal branch, SVG -posterior descending artery (PD)) and had all graft patency on follow-up CAG.He had a good clinical course after CABG. Relevant test results prior to catheterization. He was carried to ourhospital because of severe rest chest pain. His general physical examination onadmission revealed no abnormal findings. His 12-lead ECG demonstrated first degree atrioventricular (AV) block and ST-segment elevation in II, III, and aVF leads. He admitted due tothe diagnosis of inferior ST elevation myocardial infarction (STEMI). Relevant catheterization findings. Emergent CAG revealed total occlusionin the proximal native RCA and proximal portion of SVG to PD with fillingdefect. We performed primary PCI including aspiration thrombectomy for SVG toPD. However, we could not obtain the recanalization of occluded SVG because ofmassive thrombus and provided this patient with conservative therapy. 9 days later, monitor ECGrevealed advanced AV block. We decided attempting the recanalization of chronic total occlusion (CTO) of native RCA.
Case Summary. We advised the patient to do CABG, but he chose medication. Aspirin 100mg, oral daily Brilinta 90mg, oral two times a day Lipitor 20mg, oral daily Betaloc12.5mg, oral two times a day Trimedazidine20mg, oral three times a day Esomeprazole 20mg, oral daily