Severe calcified RCA subocclusion

Dr. Ander Regueiro

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

Introduction

During the past years there has been a significant growth in CTO PCI procedures with an overall success rates improvement over time. One of the most important factors associated with this progress is related to material upgrading. Use of a microcatheter is of utmost importance for CTO-PCI.

Patient profile

75-year-old male patient came to the emergency room after an episode of prolonged angina.
During the last two months he had some episodes of angina with a CCS class II.
Patient was admitted to the acute cardiac care unit with the diagnosis of NSTEMI.

Lesion type

RCA complex anatomy with tortuosity and severe calcified lesion (99%).
Excentric stenosis at the mid-segmen.
TIMI flow 1 (Figure 1).

Procedure

Despite the RCA complex anatomy with tortuosity and severe calcified lesion single access from the right radial artery was decided.
Antegrade procedure was performed. The lesion was crossed with a Fielder XT-A wire. Navitian was advanced easily crossing the lesion (Figure 2).
Fielder XT-A wire was interchanged for atherectomy wire to perform rotational atherectomy with 1.25 mm burr.
Wire was interchanged again with Navitian microcatheter (Figure 3).
Predilatation with 2.50 mm NC balloon and posterior 3.00 mm cutting balloon was performed.
Two overlapped sirolimus eluting stents (Angiolite) were implanted (3.50x24 mm and 3.50x24 mm) (Figure 4).

Conclusion

“The Navitian microcatheter provides excellent pushability and trackability. Although Navitian was used several times for wire interchanges the tip and structure of Navitian was maintained. In the presence of challenging anatomies those characteristics can help to simplify complex procedures.”

Dr. Ander Regueiro
Hospital clinic of Barcelona, Spain

Figures