Complex antegrade calcified CTO supported by a new microcatheter

Prof. Roberto Garbo

Maria Pia Hospital, GVM Care & Research, Turin, Italy. Director of CTO and Complex PCI Program.

Introduction

Chronic coronary total occlusions (CTO’s) are the most complex coronary interventions, in which operator expertise and dedicated devices play a foundamental role for the procedural success. In such complex scenario, microcatheters are essential tools and high quality performance is requested.

Patient profile

Patient 74 years old and male.
Risk factors: Diabetes and hypertension.
In December 2020 he presented effort angina, with exercise test positive at low threshold.

Lesion type

Mid LAD CTO with diffuse disease was detected (Figure 1).
LAD CTO PCI was scheduled the 26th of March 2021.

Procedure

The LAD /Diagonal presented a severe calcified CTO treated by antegrade approach.
We started with soft polymeric wire (Fielder XTR) (Figure 2), subsequent step up using Navitian with Gaia 2nd (Figure 3) and then final successful crossing with Fielder XTR (wire de-escalation technique) (Figure 4). Navitian showed a very good behaviour.
Due to severe calcification and non-dilatable lesion, rotational atherectomy was needed (Figure 5). After good lesion preparation and IVUS guidance, we performed complex Left Main - LAD /Diagonal stenting (Figure 6) with very good result (Figure 7).
At 1 month follow up he is free of angina, completely asymptomatic with better effort tolerance.