15:20 case 12 - wojcik
TRANSCRIPT
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Successful recanalization of RCA chronic total occlusion with multiple BVS implantation
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Case Summary
Demographics / CVRFs / Clinical presentation
74 years old malestable angina CCS IIIInferior wall inf. 2003PCI LAD 2009Unseccessful recanalization MB 2012Unseccessful recanalization RCA May 2014 - antegrade appr.
EKG / Non-invasive Testing
Small Q waves II, III, aVFHypokinesia of inferior wallEF 46%
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Angiography / imaging
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Initial Strategy ?
Antegrade appr. ?
Retrograde appr. ?
Others ?
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A priori Retrograde approach
Step 1: Retro guidewire passage by III septal collaterals to occluded part RCAStep 2: Direct retrograde crossing or kissing wire crossing, externalization Step 3: IVUS/OCT guided BVS Implantation
Case strategy
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Case Summary
Duration of the procedure: 190 min: Retro - > 2 h Ante – 30 min
Fluoroscopy time: 106 min
Total amount of contrast: 550 ml
Xr dose: 11510 mGy
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Key learning points
Retro:
LCA: 7F EBU 4,0SionSion blueFielder XT, FCCorsair 150 cm
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Key learning points
Ante:
RCA: 6F JR 4,0Sion + CorsairConfianza Pro 12 + Corsair
Mini Trek 1,20/12 mm-> Mini Track 2,0/30mm->Sprinter NC 3,5/27 mm
3 x Absorb 3,5/28 mm + 1 x Absorb 3,0/18 mm
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Key learning points
Learning point 1: not everything visible is crossable
Learning point 2: switch for antegrade procedureshould be after 30 min unsuccessful guidewire penetrating ?
Learning point 3: antegrade wire-based strategy ofCTO-PCI is associated with high success rates after retrograde access failure…