Navitian in chronic occlusion: Key to success in an antegrade approach

Dr. Ignacio J. Amat Santos

Director of interventional cardiology of the Hospital Clínico Universitario de Valladolid, Spain.

Introduction

Chronic total occlusion (CTO) is one of the most complex procedures to perform. Over the last few years there has been a significant growth in CTO PCIs, with an overall improvement in success rates over time. The reason for this change is due to the evolution of devices. The use of a microcatheter is of paramount importance for PCI during CTO. Recent improvements in microcatheters, in terms of navigability and pushability, offer advantages to increase safety by simplifying procedures.

Patient profile

71 years-old men admitted for unstable angina
Cardiovascular risk factors: type II diabetes mellitus and dyslipidaemia
Cardiovascular history: permanent atrial fibrillation and chronic ischaemic heart disease.
Lower MI in 2005 and a covered stent was implanted in the proximal DC.
LVEF 55%. COPD type emphysema, centrolobulillar and paraseptal.

Lesion type

RCA CTO observed by angiography (Figure 1).

Procedure

An antegrade procedure was performed.
XB3.5 guiding catheter and Bandit angioplasty guidewire positioned in the left anterior descending artery.
AL1 guiding catheter is positioned in the right coronary artery.
With Navitian microcatheter support, the Rider guide passed to the posterolateral branch (Figure 2) and Navitian advance easily (Figure 3).
Then an exchanged to Sion Blue guide was performed.
Right coronary lesions were predilated with 2.50x15 mm balloons (Figure 4) and two 3.50x48 mm DES (Figure 5,6) were implanted from distal to proximal segment of the RCA.
Angioplasty of the proximal segment of the posterolateral branch was performed with a 2.50x20 mm DCB.
IVUS was performed, showing good stent apposition and a control angiography showed a good final result (Figure 7).