Video : Very challenging retrograde RCA CTO

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Cardiology / Coronary / Cto / Case in the box

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DESCRIPTION
Equipment used

Case summary

Patient Demographics

Age: 66 years old

Gender: male

Medical History

NIDDM; Hypertension; Dyslipidaemia

Previous smoking history

Previous femoral PTCA

Known IHD:

1998: Anterior STEMI - Thrombolysis + PCI of proximal LAD (BMS)

2002: CTO of RCA: medical management

2016: ICD (EF 35% + NSVT)

Clinical Presentation

Stable angina (CCS III)

Nuclear perfusion imaging: inducible ischaemia of infero-lateral wall

Coronary angio

Normal LM

LAD:

moderate ISR (FFR 0.79)

severe stenosis mid-LAD

PCI with two overlapping DESs

M1: severe stenosis

RCA: CTO of proximal segment with septal collaterals from LAD

Strategy

ACCESSES
Radial: XB 3.5 6Fr 90 cm
Femoral: AL1 7Fr 100 cm; long sheath

APPROACHES
Retrograde approach through septal collaterals (Turnpike LP and Sion)
Retrogade true-to-true
Retrograde dissection and re-entry
Antegrade dissection reentry
Antegrade approach with guidewire escalation

Protocol: OptiRAY (Ioversol)

Concentration: 350 mgl/mL

Volume: 220 mL

Shooting date : 2017-01-26
Last update : 2021-06-09