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Case summary

  • Patient: male 58 y
  • 8 March 2016 cardiac arrest playing soccer with friends
  • VF and ROSC after successful defibrillation, normal ECG
  • 2 vessel disease:  severe stenosis of proximal RCA   CTO of proximal RCX
  • PCI march 2016:  RCA with one DES, try to open RCX, unsuccessful
  • Normal renal function, no anemia, only slight Troponin raise
  • CVRF:  dyslipidemia, hypertension, smoker
  • ICD Implantation April 2016
  • MRI 29.3.16:  LVEF 45-50%
  • Ischemia in the RCX territory
  • JCTO score 3:
  • Blunt proximal cap
  • Long lesion
  • Bending
  • Landing zone : distal cap

Description of procedure

  • Right femoral approach
  • Distal injection to check the right branch
  • Proximal cap dilatation (2.5 balloon)
  • 2.35 stent
 
 
Shooting date : 2016-06-27
Last update : 2017-08-03
Daniel Weilenmann
St. Gallen, Switzerland

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See previous comments (19)
  • Kare T. Should you be more careful with antegrade injection due to risk of hydronic dissection?

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    • Olaf R. why did he not change again to fielder XT again after penetrating the proximal cap with a stiffer wire?

      • Ayman T. i think Sion blue was used to deeply engage LCX

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    • Ayman T. very useful

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      • Umar S. Well done great job

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        • Stefan H. Congratulations, nice procedure!

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          • Raisakis K. Nice

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            • Zambonialbe A. Well done!

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              • Aquilina M. Which kind of wire do you use?

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                • Daniel W. Treating CTOs in the hybrid algorithm we use mostly as a step up approach Fielder XT, then Pilot 200, GLADIUS or GAIA family, then Conquest Pro 12 or Hornet 14. Mostly depending on the anatomic presentation of the CTO.

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                  • Daniel W. Thank you all for the comments and the support

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                    • evi supriadi S. good case, well done

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                      • Mohamed M. Good

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                        • Sarteep Ezzat Q. Thanks

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                          • Mohamed M. Good

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                            • Dirk P. Excellent result !
                              Learning point for me was the dilatation of the proximal cap with low profile balloon to facilitate the micro catheter. many thanks , Dirk P

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                              • Khalid A. great results .. I would've saved some time using a guide extension to help with the Cx angulation . but nicely done .

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                                • Hernan V. Exelent

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                                  • hashemi fard O. Excellent

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                                    • Usman K. Good case

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                                      • maher T. EXCELLENT

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                                        • dow R. https://www.google.com/

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                                          • dow R. good

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                                            • Dorin D. great job!

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