A successful treatment for a lesion of chronic total occlusion with contralateral angiography in a single radial access
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CASE REPORT
A successful treatment for a lesion of chronic total occlusion with contralateral angiography in a single radial access Reo Nakamura • Keisuke Ota • Kei Isoda Nobuyuki Miyai • Takayoshi Sawanishi • Noriyuki Kinoshita
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Received: 31 July 2013 / Accepted: 23 February 2014 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2014
Abstract A 50-year-old man was admitted due to effort chest pain. Coronary angiogram showed a total occlusion of LAD. The 5-French JL 3.5 was engaged into the left coronary artery. The XT-A guidewire was advanced to the distal of the occluded lesion. Contralateral angiography was performed using JL 3.5. The guiding catheter was pullback from the left coronary orifice leaving the guidewire at LAD, and the catheter tip was rotated clockwise to right coronary cusp for right coronary angiography. We could confirm that the guidewire was in the true lumen vessel.
visualization of retrograde collateral filling of the target vessel is often essential for successful treatment. Using the antegrade approach, opacification through the target vessel may be insufficient to visualize the CTO and the course of the potentially recanalized channel. The contralateral vessel injection may allow for visualization of the vessel segment distal to the CTO. However, it usually need a two artery access for contralateral angiography in CTO cases. Here we report on a case with lesion of CTO with contralateral angiography in a single radial access using a flexible 5 French guiding catheter.
Introduction
Case report
In recent years, with the spread of transradial coronary intervention (TRI) and use of small-diameter catheters, percutaneous coronary intervention (PCI) has been showing a tendency to less invasive. TRI is superior to transfemoral coronary intervention (TFI) in terms of increased patient comfort and lower incidence of bleeding complication, with no significant difference in success or other complication rates [1–5]. Furthermore, a previous report has pointed out that down sizing of guiding catheter reduced the mount of contrast medium, renal complications [6]. The use of small-diameter catheters is recommended so that final results are same as using bigger-diameter catheters. In the case of chronic total occlusion (CTO),
A 50-year-old man was admitted due to effort related chest squeezing for 2 months. The symptom occurred three times a month. The patient obtained prompt relief with sublingual tablets of nitroglycerin. His coronary risk factors were diabetes mellitus and dyslipidemia. Physical examination revealed no abnormalities. Roentgenogram findings of the chest showed within normal limits, and cardiothoracic ratio was 51 %. An electrocardiogram showed no specific ST-T segment change. Transthoracic echocardiography revealed mild hypokinesis in anteroseptal wall. His coronary computed tomography revealed severe stenosis or total occlusion of proximal left anterior descending artery (LAD). We made a diagnosis of effort angina pectoris from clinical course and clinical
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