A case of antegrade right coronay artery CTO PCI
Introduction
Despite advances in wire and stent technology, chronic total occlusions (CTOs) remain a difficult lesion subset to treat. CTOs are present in about 20% of patients undergoing cardiac catheterization; however, only a small percentage are offered percutaneous treatment. The current hybrid algorithm approach to CTO percutaneous coronary intervention (PCI) uses a combination of antegrade and retrograde techniques to facilitate wire crossing and procedural success. The use of specialty microcatheters and wires may facilitate engagement and crossing of the proximal cap.
Patient profile
- 70 year-old men was admitted for an anterior STEMI.
- Significant myocardial ischemia of the RCA territory was detected in myocardial perfusion scintigraphy.
Lesion type
- Acute occlusion of the mid-LAD (TIMI 0) and CTO of the proximal RCA with an antegrade filling (Figure 1).
- JCTO score was 1.
Procedure
- Antegrade wire escalation and dissection reentry was planned. Initially, a Sion Blu guide was easily introduced through Navitian. Then, it was replaced by a Whisper Extrasupport guide to track the subintimal space (Figure 2).
- A second guidewire (Pilot 200) was mounted using the “parallel wire technic to tracked the true lumen (Figure 3).
- Despite coronary calcification, progression of Navitian through the lesion was easy (Figure 4). An exchange with Sion Blue guide was performed through Navitian.
- Finally, a pre-dilatation with NC balloons was performed, and a DES was implanted.
- The final angiographic control was good with TIMI III flow and no dissection or residual stenosis (Figure 5).
Conclusion
“This is an antegrade CTO PCI of a calcified RCA. Movements with Navitian were very easy during guidewire exchange. The Navitian microcatheter showed good trackability in tortuous lesions due to its hydrophilic coating, crossability and resistance to kinking in this calcified lesion.”
Dr. Medhi Slim
Saloul Univeristy Hospital, Sousse, Tunisia
