Retrograde percutaneous recanalization of chronic total occlusion of the left anterior descending artery through an extr
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CASE REPORT
Retrograde percutaneous recanalization of chronic total occlusion of the left anterior descending artery through an extremely tortuous right ventricular branch Makoto Sekiguchi • Akito Miyajima • Syuichi Hasegawa • Masao Yamazaki Masahiko Kurabayashi
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Received: 16 December 2011 / Accepted: 22 May 2012 / Published online: 19 June 2012 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2012
Abstract We report a case of chronic total occlusion (CTO) of the left anterior descending artery, which was treated by percutaneous coronary intervention using a retrograde approach via an extremely tortuous right ventricular branch of the right coronary artery. New concept guidewires and a channel dilator were advanced by delicate manipulation into the distal site of the CTO and a successful percutaneous recanalization was performed. These new concept guidewires may facilitate the retrograde approach for CTOs via tortuous collateral channels.
lead to serious and dangerous complications. We describe the case of a 47-year-old male with CTO of the left anterior descending artery (LAD), who underwent successful recanalization via a retrograde approach by precise and safe tracking of an extremely tortuous epicardial channel. New concept guidewires and a Corsair microcatheter were used for the procedure.
Keywords Percutaneous coronary intervention Collaterals Total occlusion
A 47-year-old male with a history of coronary artery disease was admitted to our hospital with CTO in his LAD. His medical history revealed familial hypercholesterolemia as a coronary risk factor and an episode of acute coronary syndrome with cardiogenic shock 2 years ago, for which he underwent PCI of the proximal right coronary artery (RCA) with a Multilink Vision (4.0 mm 9 23 mm) stent (Abbot Vascular, Santa Clara, CA). At that time, he was also diagnosed with CTO in the middle third of the left anterior descending artery (LAD). However, the first PCI of the LAD, which was performed 1 month later via the conventional antegrade approach, failed. The patient was consequently admitted to our hospital to undergo a second PCI via the retrograde approach, which would prove to be quite challenging. The most recent coronary angiogram revealed an eccentric stenosis and CTO in the middle third of the LAD, which was receiving collateral flow only from the right ventricular (RV) branch of the RCA (Fig. 1a). The RV branch had become thick and extremely tortuous (Fig. 1b). The echocardiography demonstrated normal findings without regional wall motion abnormality. The Thallium scintigraphy at rest demonstrated a mild defect only in the inferior wall. PCI was initiated through the bilateral femoral arteries. An 8 French (Fr) CLS4.0 guiding
Introduction The retrograde approach through collateral channels for percutaneous coronary intervention (PCI) has recently become a widely used alternative method for recanalization of chronic total occlusion (CTO) [1–3]. In particular, the development of the Corsair microcatheter (Asahi Intecc Co.
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