Successful percutaneous coronary intervention of a chronic totally occluded left anterior descending artery via an ipsil
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CASE REPORT
Successful percutaneous coronary intervention of a chronic totally occluded left anterior descending artery via an ipsilateral intraseptal channel using intravascular ultrasound-guided retrograde wire-crossing technique Yohei Numasawa • Hiroyuki Motoda Hiroyuki Yamazaki • Toshiki Kuno • Toshiyuki Takahashi
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Received: 27 May 2013 / Accepted: 12 August 2013 / Published online: 23 August 2013 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2013
Abstract We herein report a 59-year-old man with a chronic totally occluded left anterior descending artery treated by percutaneous coronary intervention via an ipsilateral intraseptal channel using an intravascular ultrasound-guided retrograde wire-crossing technique. When an antegrade approach is not feasible or fails, a retrograde approach to a chronic totally occluded lesion is reasonable. However, a retrograde approach from the contralateral coronary artery is not always feasible. We herein report that an ipsilateral intraseptal channel can serve as one route by which to perform a retrograde approach to chronic totally occluded lesions of the left anterior descending artery.
intravascular ultrasound (IVUS)-guided technique, and subintimal tracking technique, has contributed to an improved success rate of PCI for CTO lesions. Furthermore, when an antegrade approach is not feasible or fails, a retrograde approach to CTO lesions has been widely performed with a high success rate and acceptable complication rate [6–10]. However, an ipsilateral retrograde approach via an intraseptal channel for CTO lesions of the left anterior descending artery (LAD) is a relatively rare procedure. There are only a few case reports and a paucity of data regarding this technique [11–14]. We herein report a case of successful PCI of a CTO lesion of the LAD via an ipsilateral intraseptal channel using an IVUS-guided retrograde wire-crossing technique.
Keywords Percutaneous coronary intervention Chronic total occlusion Retrograde approach Case report Introduction Some previous studies reported that successful recanalization of chronic total occlusion (CTO) lesions of the coronary artery led to clinical benefits such as improved angina symptoms, left ventricular dysfunction, and longterm prognosis [1–5]. However, percutaneous coronary intervention (PCI) for CTO lesions remains one of the most technically challenging procedures for interventional cardiologists. The remarkable technical advancement of the antegrade approach, including the parallel wire technique,
Y. Numasawa (&) H. Motoda H. Yamazaki T. Kuno T. Takahashi Department of Cardiology, Ashikaga Red Cross Hospital, 284-1 Yobe-cho, Ashikaga, Tochigi, Japan e-mail: [email protected]
A 59-year-old man was referred to our hospital with a chief complaint of dyspnea on exertion. Chest X-ray revealed expansion of the cardiothoracic ratio, pulmonary congestion, and pleural effusion on both sides. Electrocardiography revealed nonspecific ST-T segment changes, but there were no clear fi
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