Long length chronic total occlusion in the RCA

Dr. Ander Regueiro

Hospital Clinic of Barcelona, Spain. Head of the CTO programme in the HD.

Introduction

There are several factors to take into account when choosing the material for CTO PCI including approach and lesion characteristics. Recent improvements in microcatheters in terms of deliverability and pushability offer advantages to increase safety and success rate in CTO PCI. Proper selection of a microcatheter can decrease procedural times and improve outcomes.

Patient profile

A 62-year-old male underwent a coronary angiography with the diagnosis of progressive angina.
The patient had a history of heavy smoking.

Lesion type

CTO at the mid-segment of the right coronary artery (RCA).
The occluded segment was long (40 mm) with a 100% of severity, the proximal cap was tapered with a side branch just before the occlusion (Figure 1).
The distal vessel was visible through collateral flow coming from septal branches of the LAD (Figure 2).

Procedure

Antegrade procedure was performed with a bi-radial approach access.
Bilateral injection showed a long CTO of the RCA (Figure 3)
A Fielder XT-A wire crossed the lesion. After confirming the position of the wire the Navitian microcatheter easily crossed the lesion (Figure 4).
3 DES were implanted (2.75x33 mm; 3.00x38 mm and 3.50x18 mm). Post-dilatation with a 3.50 mm NC balloon was performed in the proximal and middle segments of the RCA with a good final result (Figure 5).

Conclusion

“In this case a bilateral approach with a 6F antegrade catheter was used. Even though the occluded segment was long, the Navitian microcatheter provides a good pushability than can help to simplify procedures.”

Dr. Ander Regueiro
Hospital clinic of Barcelona, Spain

Figures