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Cardiology / Coronary / Cto / Case in the box
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Patient history

  • Male, 80 years-old
  • High blood pressure
  • Stable angina, normal EKG and echocardiography
  • Large inferior ischemia on cardiac MRI (4-5 segments/17)

Description of lesion  

  • Mid LAD Occlusion
  • Calcification - JCTO score 1
  • Good Collaterality  from RCA
  • Ambiguous origin with branchs
  • Two vessel disease, Circ already treated (stent deployment needed very high pressure)

Description of procedure

  1. LAD recanalisation without post-dilatation stenting
  2. Re-occlusion followed by Second recanalisation and DES stenting 
  • Antegrade approach, with AL2 6 french, Finecross and fielder XT
  • Bilateral injection (1 femoral, 1 radial)
  • Laser as first intention because of difficulty to open the circumflex artery

Devices used

  • ELCA laser ablation catheter (Spectranetics)
  • CVX-300

Learning Points:

  • Role of simple balloon angioplasty
  • How to access and treat a proximal and mid LAD occlusion
Shooting date : 2014-07-01
Last update : 2021-06-09
Thierry Lefèvre
Massy, France
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Peter O'Kane, Md
Bournemouth, United Kingdom
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3 comments
Join the Discussion
  • jehangeer H.

    jehangeer H. RISK OF PERFORATION?

    2017-01-06, 19h38
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    • Vinod N.

      Vinod N. Thanks

      2018-11-10, 14h52
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      • Mohamed amine R.

        Mohamed amine R. RCA , not LAD

        2022-04-16, 19h29
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