逆向导丝技术开通CTO一例

丁风华

上海交通大学医学院附属瑞金医院心内科

2016.05.27 上海

• Female 54y

• Risk factor: HTN

• Stable angina for 5 months

• Laboratory tests:

– WBC 6.7*109/L, HGB 117 g/L, PLT 247*109/L

– SCr 66 μmol/L, K+ 4.2 mmol/L, LDL-C 3.0

mmol/L, CK-MB 3.1 ng/mL, TNI 0.01 ng/mL

• X-ray: N; UCG: LVEDD 51 mm, EF 58%

病史

ECG

CAG

CAG

CAG

CAG

• 3-vessel disease with Syntax score of 34.5 – CTO @ pLAD with 2 feeding artery (RCA & Septal) and J-

CTO score = 1

– Subtotal occlusion @ LCX

– Moderate-to-severe stenosis @ pRCA

Characteristic findings of

coronary artery lesions

PCI strategy

• PCI was preferred over CABG by the

patient.

• PCI for LAD with antegrade wiring first,

and retrograde wiring was the second

option.

Antegrade wiring

6 F EBU 3.5 GC + Runthrough → Septal +

Finecross 150 mm + Fielder XT

Antegrade wiring

• Miracle 3.0→sub-

intimal

• Now what

– Parallel wiring

technique

– STAR

– IVUS

– Retrograde wiring

Which channel ?

侧支够粗够直

Retrograde wiring

Finecross 150 mm + SION

Retrograde wiring

Finecross 150 mm + Fielder XT

Seesaw wiring

Recanalization

Modified Rendezvous

Angioplasty (1)

1.25*15 mm

Angioplasty (2)

2.0*20 mm

After angioplasty

Stent deployment (1)

DES 2.5*38 mm

Stent deployment (2)

DES 3.0*38 mm

After stent deployment

PCI for LCX

Runthrough + 2.0*20 mm

Stent deployment

DES 2.5*38 mm + 2.75*23 mm

Post-dialation for LCX

NC balloon 3.0*15 mm

Post-dialation for LAD

NC balloon 3.0*15 mm

Final results

Final results

CTO algorithmCareful analysis of

CAG/MSCT

Proximal CAP

ambiguity

Poor quality distal

vessel

Antegrade wire

based approach

Parallel wiring +/-

IVUS-guided wiring

Dissection-reentry

(CrossBoss/Stingray)

In-stent restenosis)

Consider use of CrossBoss

as Primary crossing strategy

IVUS-guided entry

Interventional

collaterals present

Retrograde

approach

No

No

Yes

Yes No

NoYes

XT/XTR

Gaia

Conquest

谢谢！