Antegrade coronary angioplasty of LMCA, LAD and Cx

Dr. Cristian Reyes
Dr. Cristian Reyes

Organización Clinica General del Norte Barranquilla, Colombia. Head of Interventional Cardiology and Structural Organization Department.

Introduction

Despite the great challenges faced by Interventional cardiologists, these days the development of new technologies and devices have managed to provide therapeutic alternatives that offer excellent clinical results. Within this field, new coronary microcatheter technologies such as iVascular’s Navitian are certainly a fundamental tool when handling complex clinical cases. Their versatility, flexibility, navigability, radiopacity and excellent support are vital to the success of our work.

Patient profile

  • 86-year-old male patient admitted for NSTE-AMI.
  • Risk factors: diabetes type II, hypothyroidism and ischaemic CVD.
  • ECG shows extensive anterior subepicardial ischaemia and segmental wall motion abnormalities in the anterior and lateral wall.
  • The echocardiogram shows LVEF of 35%.

Lesion type

  • Severe, diffuse coronary artery disease affecting 90% from the origin to the distal third of the LAD and severe calcification.
  • The first diagonal artery, a very small calibre vessel, was found to have severe disease affecting 90%.
  • There was coronary artery disease affecting 70% in the distal circumflex artery (Figure 1).
  • The RCA was 100% occluded. According to EuroSCORE, this is a high-risk patient with complex high-risk anatomy.

Procedure

  • The LAD was treated, exhibiting diffuse disease, very tortuous anatomy and difficult access to the lesions (Figure 2). A PT2 guidewire was inserted in the distal third and IVUS was used to confirm the ostial lesion in the LAD and LMCA.
  • The Navitian microcatheter was used to exchange the guidewire for a RotaWire and rotablation was performed with 1.25 and 1.5mm olive-shaped burrs from the LMCA to the middle third of the LAD.
  • Navitian was used to exchange it for the ChoICE extra support guidewire, providing excellent support, navigability and radiopacity (Figure 3).
  • Balloon angiosplasty was performed, followed by a 2.50x30 mm DES from the middle to the distal third and a 3.50x20 mm DES in the proximal segment. A 4.00x12 mm stent was implanted from the distal LMCA to the LAD and postdilatation was performed with a 4.00x8 mm NC balloon catheter (Figure 4).
  • Finally, a kissing balloon technique was performed with a 4.00x15 mm NC balloon catheter from the LMCA to the LAD and a 3.25x20 mm NC balloon catheter to the circumflex.
  • Correct positioning and expansion was confirmed by IVUS (Figure 5).
  • The angiographic result was excellent in the distal LMCA, LAD and circumflex.

Conclusion

“The Navitian microcatheter provided excellent pushability, navigability and support in diffuse and critical lesions. Navitian exhibited very good performance in complex anatomies. Complications during the procedure were simplified with the use of iVascular’s Navitian coronary microcatheter.”

Dr. Cristian Reyes 
Organización Clinica General del Norte Barranquilla, Colombia

Figures
Figure 1. Pre-procedure angiography showing complex anatomy
Figure 1. Pre-procedure angiography showing complex anatomy
Figure 2. Guidewire advancement through tortousity
Figure 2. Guidewire advancement through tortousity
Figure 3. Navitian microcatheter advancement distally
Figure 3. Navitian microcatheter advancement distally
Figure 4. LAD angiographic result
Figure 4. LAD angiographic result
Figure 5. LM and LCX angiographic result
Figure 5. LM and LCX angiographic result
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