Navitian use to cross a calcified CTO
Introduction
Use of a microcatheter is crucial for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Several microcatheters have recently been introduced in clinical practice aiming to improve deliverability and pushability, therefore increasing safety and the rate of success of these procedures. The recently developed microcatheters offer additional options for guidewire support during CTO PCI and selection of the appropriate microcatheter is associated with decreased procedural time and improved outcomes.
Patient profile
- A 71 year-old male arrived to the hospital with effort angina.
- Risk factors: diabetes mellitus, hypertension and obesity.
Lesion type
- LAD was mildly diseased while the ostial LCX had a significant stenosis (70%).
- The mid-RCA had a calcified occluded segment (CTO) with TIMI 0 (Figure 1).
Procedure
- Homo- and contralaterals injections with Navitian needed to be done (Figure 2).
- Antegrade procedure was performed. We started wire scalation with Fielder XT through Navitian 150cm. As the coronary artery was severely calcified and the guide catheter support was poor, we switched to Gaia II.
- The guidewire could crosss the lesion and Navitian advanced easily to the occlusion site. We used rotational maneuvers with Navitian to cross the lesion keeping the structure perfectly. (Figure 3).
- Subsequently, Navitian also was used for wire exchange to rotablator of 1.75mm burr.
- 2 long DES with 4.00mm diameter were implanted showing an excellent result (Figure 4).
Conclusion
“Navitian was excellent improving support during the procedure and crossing the lesion, even when microcatheter´s rotations were needed. Navitian’s tip and structure was perfectly maintained along all the procedure. Furthermore, Navitian has outstanding features also for wire/rotablation exchange and distal injections.”
Dr. Phillipe Garot
CEO Institut Cardiovasculaire of Massy, France
