Extraordinary use of Navitian in 19 years RCA-CTO

Prof. Jaroslaw Wojcik

Invasive Cardiology Hospital, Poland. Founder and President of the Board Ikardia Hospital.

Introduction

CTO procedures remain the most challenging ones in invasive cardiology. The most difficult part of each procedure is crossing CTO body with dedicated wire and microcatheter. Despite of significant technical progress, there is no ideal and universal tool on the market.

Patient profile

74 year-old male patient with a very long history of ischaemic heart disease was admitted to our hospital for planned RCA CTO procedure.
He already had PCI for LAD and CX with BMS in 2002 where the current RCA CTO was already recognised at that time.
In March 2021, due to diffuse in stent restenosis (ISR) and progression of disease in both vessels he had next PCI of LAD and CX with implantation of 2 DES. In this setting the decision of recanalization of CTO RCA was undertaken.
The patient was fully symptomatic CCS II and sometimes CCS III, with his EF 25%.

Lesion type

19 years old (228 months) of the RCA CTO (Figure 1).
CTO assessed of EuroScore and JCTOScore as 3.

Procedure

Primary strategy was antegrade approach. Wire escalation technic (AWE) started with Gaia 1st. Finally, Gaia 3rd successfully crossed the occlusion.
Navitian was advanced surprisingly easy and crossed the lesion (Figure 2).
Contrast medium was injected through Navitian to confirm the proper position in true lumen (Figure 3).
The soft wire was placed through Navitian in the distal part of RCA. Navitan was removed in typical manouver.
2 DES were implanted and the final result was good (Figure 4).

Conclusion

“The Navitian microcatheter provides excellent pushability and trackability in the setting of so old (19 years) and potentially very hard and difficult CTO lesion.”

Prof Jaroslaw Wojcik
Invasive Cardiology, Poland

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