A successful treatment for a lesion of chronic total occlusion using a virtual 3 Fr guiding catheter
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CASE REPORT
A successful treatment for a lesion of chronic total occlusion using a virtual 3 Fr guiding catheter Reo Nakamura • Keisuke Ota • Nobuyuki Miyai Takayoshi Sawanishi • Noriyuki Kinoshita • Katsushige Matsumoto
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Received: 10 February 2012 / Accepted: 3 June 2012 / Published online: 19 July 2012 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2012
Abstract A 43 year-old man was admitted due to effort related chest squeezing for 3 months. Coronary angiogram showed a total occlusion of the proximal right coronary artery (RCA) with collateral vessels from left anterior descending artery. The 5F sheathless guiding catheter was engaged into the RCA and the 3F JL3.5 catheter was inserted into left coronary artery via left radial artery for simultaneous contra lateral angiography. We advanced the wire through the lesion with 2 wire technique. Three XIENCE stents (2.5 mm 9 28 mm) was inserted from distal to mid RCA, and a 3.0 mm 9 15 mm XIENCE stent was inserted to proximal RCA. The final angiographic result showed well expanded stent. The treatment of chronic total occlusion could be possible even slender device by getting hold of the characteristics of the device and evaluating an objective assessment of lesion characteristics. Keywords Percutaneous coronary intervention Chronic total occlusion Minimum invasive intervention
Introduction In recent years, with the spread of transradial coronary intervention (TRI) and use of small-diameter catheters, percutaneous coronary intervention (PCI) has shown a tendency to be less invasive. Natsuaki et al. [1] showed transradial PCI reduced 30 day puncture site bleeding event
compared to transfemoral PCI, with similar PCI success rate. Other recent studies showed that TRI and use of smalldiameter catheters has been reported to reduce bleeding complications and vascular injury of puncture site [2–5]. Furthermore, a recent report has pointed out that down sizing of guiding catheter and the use of a power injector reduced the amount of contrast medium delivered in coronary angiography without reducing angiographic image quality [6]. The use of small-diameter catheters is recommended so that final results are the same as using bigger-diameter catheters. In recent years, sheathless guiding catheters have been developed to reduce the catheter size [7, 8]. Recently, a virtual 3 Fr PCI using WORKS system (Medkit CO., Ltd. Tokyo, Japan) with its outer diameter of 0.067 in. (1.70 mm) and inner diameter of 0.059 in. (1.50 mm) was reported [9]. Because the outer diameter of this system is comparable to that of a conventional 3-Fr introducer sheath, with the inner diameter being close in size to a conventional 5-Fr guiding catheter, this system is called a virtual 3-Fr guiding catheter. In this system, successfully treated cases with complex lesions have also been reported [10]. The WORKS system is the smallest sheathless guiding catheter, and can reduce the complications of the puncture site by using well. Here we report on a case with lesion of chronic
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