CORONARY - Chronic Total Occlusion
Percutaneous Coronary Intervention of Calcified CTO RCA in a Symptomatic Elderly Patient
Khin Maung Zan @ Mohd Saad Jalaluddin1
National Heart Institute, Malaysia1,
Baseline creatinine- 113
hs Troponin T- 17HbA1C- 6.3LDL-C 1.3
We proceeded with PCI to CTO RCA with SAL 1 guiding catheter and finecross. We were unable to cross the CTO lesion with Fielder XT wire, Gaia second. We attempted parallel wiring but failed. Decided to proceed with PCI to Intermediate artery and LAD instead and to re-attempt PCI to CTO RCA later. We have successfully done PCI to intermediate artery with DCB SEQUENT PLEASE NEO 2.0X20 mm at 6 atm. We stented LAD lesion with DES 2.75x32 mm and post-dilated with NC balloon 3.0x15 mm at 18 atm. She developed contrast induced nephropathy but it improved with hydration.
She presented again 3 weeks later with similar chest pain with ECG showing similar changes and echocardiogram showed good EF 58%. We re-attempted PCI to CTO RCA with SAL 1/6R guide with Cosair Pro 150 cm via right femoral and optitorque 5F to left system. We failed to cross the lesion with Fielder XT, Pilot 150 and Conquest Pro 9 and 12. Wires kept going to false lumen. We changed the guide to SAL 1/7F with sideholes and floppy wire to RV branch with anchored balloon. We did ADR with looped Fielder XT-A. Attempted to pass STINGRAY was not successful. We did POBA to distal and mid RCA with 1.5x10 balloon. We were able to pass STINGRAY distally and crossed via ADR to distal RCA with Conquest Pro 12. Exchanged to soft wires and predilatation done. We stented RCA with DES 2.5 x 48 mm, 3.0 x 32 mm and 3.5x 38 mm. Post-dilatation was done with NC 3.5 x 15 mm. We achieved a good result. tctap2021-8.avi tctap2021-10.avi
It was a case of successful percutaneous coronary intervention to CTO RCA with ADR technique in an elderly patient with multiple comorbidities. We attempted twice with multiple wires including parallel technique. We failed on the first attempt but we successfully crossed for the second time. Failed PCI is not a bad outcome.