E-Case

JACC

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-076

A Case of Successful PCI of RCA Chronic Total Occlusion (CTO) With AnteOwl WR¢â IVUS-Guided Parallel Wiring Technique for Recanalization From a Large False Lumen

By Yukihiro Yamaguchi, Toshiya Muramatsu, Reiko Tsukahara, Masatsugu Nakano, Hideyuki Takimura, Satoru Nishio, Yukako Takimura, Mami Kawano, Emi Tajima, Ippei Tsuzuki, Rintaro Taniguchi

Presenter

Yukihiro Yamaguchi

Authors

Yukihiro Yamaguchi1, Toshiya Muramatsu2, Reiko Tsukahara1, Masatsugu Nakano1, Hideyuki Takimura1, Satoru Nishio1, Yukako Takimura1, Mami Kawano1, Emi Tajima1, Ippei Tsuzuki1, Rintaro Taniguchi1

Affiliation

Tokyo General Hospital, Japan1, Tokyo Heart Center, Japan2,
View Study Report
TCTAP C-076
CORONARY - Chronic Total Occlusion

A Case of Successful PCI of RCA Chronic Total Occlusion (CTO) With AnteOwl WR¢â IVUS-Guided Parallel Wiring Technique for Recanalization From a Large False Lumen

Yukihiro Yamaguchi1, Toshiya Muramatsu2, Reiko Tsukahara1, Masatsugu Nakano1, Hideyuki Takimura1, Satoru Nishio1, Yukako Takimura1, Mami Kawano1, Emi Tajima1, Ippei Tsuzuki1, Rintaro Taniguchi1

Tokyo General Hospital, Japan1, Tokyo Heart Center, Japan2,

Clinical Information

Patient initials or Identifier Number

NS 258456

Relevant Clinical History and Physical Exam

¡¡The patient was a male in his 50s and his diagnosis  was SMI (Silent Myocardial Ischemia). CAG showed CTO at #3-4 AV in a previous  hospital, but PCI was failure. Then he was referred to our hospital. LVEF was  58% (UCG) and eGFR was 74 (ml/min/1.73m2). 

Relevant Test Results Prior to Catheterization

 Cardiac CT showed that the entry site of CTO was  tapered and there was no severe calcification. The lesion was so tortuous and  there was RV branch just before the lesion. The predicted occlusion length was  40 mm (J-CTO score 3).

Relevant Catheterization Findings

¡¡The initial  angiography showed the CTO at RCA distal seg. 3 occluded from RV branch. The  collateral channel was absent from LCA and that of from RV branch to seg. 4  was very poor, therefore, the retrograde approach was not an option. We would like to show the bail-out procedures.

Interventional Management

Procedural Step

 We tried to cross the lesion with FINE CROSS GT and  XT-R from the antegrade, but the tip of the wire strayed into the myocardium  through the false lumen, causing leakage of contrast medium into it. In  addition, a large dissection was found in RCA. It was a perforation  within the CTO and did not lead to cardiac tamponade. Then, a parallel wiring technique was attempted under AnteOwl  WR¢â intravascular ultrasound (AO-IVUS) guidance. AnteOwl WR¢â is a new IVUS specifically  developed in Japan for CTO-PCI. Tip-to-sensor position is as short as 8mm and  the shaft is reduced in diameter to 3.1Fr, allowing simultaneous use of IVUS  and 2 micro catheters or micro catheter and 0.014 guidewire within a 7Fr guide  catheter.  AO-IVUS was inserted on the wire in the false lumen, and  while observing the true lumen with it, GAIA NEXT 1st with the tip 0.8mm (for 3coils) bent at 45 degrees, could advance to the distal part of CTO in all true  lumen from the entry site.2 U-SESs were implanted and the PCI was successful.

Case Summary

 We performed  a successful PCI of RCA chronic total occlusion (CTO) with AO-IVUS-guided  parallel wiring technique for recanalization from a large false lumen. AnteOwl WR¢â is ideal for IVUS-guided PCI because  of its short tip-to-sensor distance, small shaft diameter, and good  passability.