Video : Uncrossable LAD CTO

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Cardiology / Coronary / Cto / Case in the box

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Patient history

Male, 70 years old
Dyslipidemia, smoking, High blood pressure
Previous Pace maker in 2006 and CRT-D in 2011
Admitted for acute pulmonary oedema. EKG normal
Echo: anterior hypokinesia with EF 30%.
MRI: anterior viability 100%
Previous attempt to reopen LAD failed

Description of lesion

Long occlusion of mid LAD
Length > 20mm
Calcification
Entry point: blunt stump
Retry
JCTO score 4

Description of procedure

Bilateral approach, left and right radial
Antegrade failure with fine cross and wire escalation (Fielde XT, Ultimate and Gaia 2
Retrograde approach with corsair
Retrograde crossing with Gaia 2 and Corsair
Need for septal pre-dilatation
Need for creating a shorter guide
Need for mother and child technique
Position loose
Antegrade crossing with Gaia 2 using the retrograde channel created with Corsair
Undilatable lesion and need for laser

Learning points

Contrast media 480 cc
Xray exposure 7.9 Gray
How to shorten a guiding catheter
Laser for undilatable lesions
Antegrade crossing with Gaia 2, through the retrograde channel created by Corsair

Shooting date : 2014-07-01
Last update : 2021-06-09