Lots of interesting abstracts and cases were submitted for TCTAP 2023. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!

TCTAP C-069

LAD CTO Post CABG With Short Aneurysm

By Yen-Lien Chou

Go for JACC 0

Presenter

Yen-Lien Chou

Authors

Yen-Lien Chou¹

Affiliation

Tri-Service General Hospital, Taiwan¹,

View Study Report

TCTAP C-069

CORONARY - Chronic Total Occlusion

LAD CTO Post CABG With Short Aneurysm

Yen-Lien Chou¹

Tri-Service General Hospital, Taiwan¹,

Clinical Information

Patient initials or Identifier Number

1655423

Relevant Clinical History and Physical Exam

63-year-old man, non-smoker Hypertensive cardiovascular disease, hyperlipidemia, old stroke(lacunarand TIA), Dementia, hepatitis BCAD, 3VD s/p CABGx4 on 2017 (LIMA to LAD, VGto LCx & OM, VG to PDA)Intermittent chest tightness, exertionaldyspnea, and radiation to left shoulder for months

Relevant Test Results Prior to Catheterization

ECG showed sinus rhythm and QS pattern over V2-V4CXR revealed normal heart border and mild emphysematous change over bilateral lungEchocardiography showed preserved LVSF with EF: 70%, mild TR, Grade II diastolic dysfunction and PAP: 35mmHgTl-201 revealed ischemia over the anterior wall about 20-30%

Relevant Catheterization Findings

LM: patent, Medina (0,1,1)LAD: - Ostium: Chronic total occlusion (CTO)without stump, Medina (0,1,0)- P/3: CTO and critical stenosis - M/3: Tandem discrete eccentric 70-95%stenosisLCx: CTO at M/3RCA: CTO from OstiumVG to LCx and OM1: PatentVG to RCA: PatentLIMA to LAD: TIMI II flow to p to m-LAD andTIMI III flow to d-LAD

2.mp4

3.mp4

4.mp4

Interventional Management

Procedural Step

Antegrade approach from bilateral femoral arteryDevices: - Guiding catheter: EBU 3.5 (6.0Fr withS.H.)- Guiding wire: SION Black, Fielder XT-A, Gaia - Device: IVUS, double lumen catheterIVUS-guided from LCx for confirmation with LAD ostiumWire to LCx firstly and and advance double lumen catheter to LMAntegrade Wire escalation with Fielder XT-A,Gaia III, and Conquest proHowever, wire dislodgeGaia III cross the proximal cap of CTO by microcatheter but More resistance during wiringHornet 10 was used for further wiring and successfully enter distal CTO capGuideliner + 1.0mm CTO balloon to enter the CTO bodyIVUS post 2.0mm semi-compliant balloonPre-dilation with 2.5 cutting balloon and2.5mm NC balloonStent deployment from distal LAD to LM by provisional technique with LCx ostium

5.mp4

6.mp4

7.mp4

Case Summary

IVUS guidance for LAD ostium CTO is necessaryDouble lumen catheter is a good tool for LAD ostium CTO for increasing supportWhich is better ？ LIMA Vs. LAD CTOVs. Do nothing Stent cross LIMA anastomosis is still an issue in post-CABG cases？ PCI with coronary aneurysm is challenging, full expansion with vasvular or reaches the minimal stent area (MSA) by IVUS guidance

Back

E-Case

TCTAP C-069