Intravascular ultrasound-guided chronic total occlusion wiring technique using 6 Fr catheters via bilateral transradial
- PDF / 543,613 Bytes
- 4 Pages / 595.276 x 790.866 pts Page_size
- 48 Downloads / 161 Views
CASE REPORT
Intravascular ultrasound-guided chronic total occlusion wiring technique using 6 Fr catheters via bilateral transradial approach Makoto Nakashima • Yuji Ikari • Jiro Aoki Kengo Tanabe • Shuzou Tanimoto • Kazuhiro Hara
•
Received: 8 June 2013 / Accepted: 31 January 2014 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2014
Abstract A blunt stump-type entry of chronic total occlusion (CTO) is one of the most difficult morphologic features to overcome in percutaneous coronary intervention (PCI), which often requires the guidance of intravascular ultrasound (IVUS) to identify the entry point. However, realtime, IVUS-guided PCI usually requires an 8 Fr guiding catheter. In this report, we describe a successful PCI for blunt stump CTO using bi-radial, IVUS-guided CTO wiring technique. Two 6 Fr guiding catheters (one as an operating guidewire; second for IVUS imaging) were simultaneously inserted into the left coronary artery via bilateral radial arteries. This technique may be useful for CTO intervention. Keywords Chronic total occlusion IVUS-guided wiring technique Transradial coronary intervention
Introduction Successful percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has been shown to be an effective treatment to reduce angina symptoms and the need for bypass graft surgery, and some studies showed the improvement of long-term outcome after successful recanalization of CTO lesion [1]. A blunt-type entry is a contributing factor for unsuccessful PCI for CTO lesions because of the M. Nakashima (&) J. Aoki K. Tanabe S. Tanimoto K. Hara Division of Cardiology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo 101-8643, Japan e-mail: [email protected] Y. Ikari Division of Cardiology, Tokai University School of Medicine, Isehara, Japan
difficulty in locating the true entry point [2]. The guidance of intravascular ultrasound (IVUS) imaging is useful to identify the precise entry point of an occluded artery. However, a relatively larger guiding system such as an 8 Fr catheter is needed to perform real-time IVUS-guided CTO wiring. Here, we describe a case of successful 6 Fr bilateral transradial coronary intervention (TRI) of a blunt stump left circumflex artery (LCX) CTO, using IVUS-guided wiring technique with a double-guiding catheter technique. A 47-year-old man was admitted to our hospital because of ischemic changes in an electrocardiogram. His coronary risk factors were dyslipidemia and current smoking status. A coronary angiography revealed CTO in the mid-to-distal portion of the LCX (Fig. 1a). Cardiac magnetic resonance imaging showed subendocardial infarction of the posterolateral (PL) wall that preserved myocardial viability. Then, we attempted PCI to recanalize CTO of the LCX. A 6 Fr Ikari left 4 (IL4) guiding catheter (Terumo Co., Tokyo, Japan) was inserted via the right radial artery into the left coronary artery (LCA), and the second 6 Fr IL4-guiding catheter was inserted from the left radial artery into the ri
Data Loading...
