A Case of Successful Antegrade Wire Escalation supported by Navitian microcatheter for a RCA CTO
Prof. Carlo Di Mario, President of EuroCTO club and Dr. Niccolò Ciardetti.
Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
Introduction
Microcatheters are an essential tool in complex percutaneous coronary interventions (PCI), especially in CTOs which represent the acme of complexity in coronary interventions. Those devices have been through constant and continuous technical evolutions, which today allows CTO operators to count on a wide range of devices with different characteristics and functions, which makes it possible to choose the one best suited to the need of the procedure. So, the microcatheters should be used in every CTO PCI attempt, whether the anterograde or retrograde approach is chosen because its use improves the success of CTO PCI while achieving greater safety.
Patient profile
- 56 years-old men.
- Cardiovascular risk-factors: previous smoker, dyslipidaemic, family history of CAD.
- The ECG was no inferior Q waves, cardiac MRI showed inferior LGE <50%.
- Dobutamine stress echo confirmed inferior myocardial viability.
Lesion type
- CTO on proximal RCA.
- The proximal RCA CTO had ipsilateral collaterals and contralateral from LCx (Figure 1).
Procedure
- The RCA was engaged with a 7 Fr Judkins right GC using a balloon-assisted tracking technique to avoid vascular complications on the arm.
- An antegrade wiring was planned and we started with a Fielder XT-R Asahi I guidewire supported by the Navitian 135 cm microcatheter (Figure 2).
- Since the wire was not able to be steered towards the occlusion, we stepped-up with a Gaia first from Asahi wire, supported by as well by Navitian (Figure 3), obtaining a successful crossing of the occlusion.
- The Navitian microcatheter followed easily the wire (Figure 4) and, after wire removal, a manual injection through Navitian confirmed intraluminal crossing and no distal disease (Figure 5).
- A Sion Blue ES wire from Asahi was inserted through Navitian and it was removed with trapping technique.
- After a predilatation with 2.50x20 mm, a DES 3.00x33 mm was deployed to the proximal segment (Figure 6).
- Angiography showed an excellent result with TIMI 3 flow and residual stenosis <30% (Figure 7).
- The patient was discharged the day after without acute complications.
Conclusion
"The Navitian microcatheter adequately supported the guidewires, crossed the occlusion effectively and allowed a good distal injection, fulfilling all the necessary requirements for a microcatheter for antegrade crossing. The Navitian microcatheter therefore is a valuable addition to the essential armamentarium for the CTO recanalization and represents a good choice in case of antegrade approach."
Prof. Carlo Di Mario, and Dr. Niccolò Ciardetti
