Video : CTO of proximal RCX

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Cardiology / Coronary / Cto / Case in the box

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Case summary

Patient: male 58 y
8 March 2016 cardiac arrest playing soccer with friends
VF and ROSC after successful defibrillation, normal ECG
2 vessel disease: severe stenosis of proximal RCA CTO of proximal RCX
PCI march 2016: RCA with one DES, try to open RCX, unsuccessful
Normal renal function, no anemia, only slight Troponin raise
CVRF: dyslipidemia, hypertension, smoker
ICD Implantation April 2016
MRI 29.3.16: LVEF 45-50%
Ischemia in the RCX territory

JCTO score 3:
Blunt proximal cap
Long lesion
Bending

Landing zone : distal cap

Description of procedure

Right femoral approach
Distal injection to check the right branch
Proximal cap dilatation (2.5 balloon)
2.35 stent

Shooting date : 2016-06-27
Last update : 2017-08-03

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See previous comments (19)

Kare T. Should you be more careful with antegrade injection due to risk of hydronic dissection?

2017-02-18, 19h50
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Olaf R. why did he not change again to fielder XT again after penetrating the proximal cap with a stiffer wire?

2017-02-18, 23h25
- Ayman T. i think Sion blue was used to deeply engage LCX
  
  2017-02-19, 0h49
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Ayman T. very useful

2017-02-19, 0h48
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Umar S. Well done great job

2017-02-19, 5h26
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Stefan H. Congratulations, nice procedure!

2017-02-19, 23h01
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Raisakis K. Nice

2017-07-03, 0h07
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Zambonialbe A. Well done!

2017-10-01, 17h02
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Aquilina M. Which kind of wire do you use?

2017-10-02, 17h14
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Daniel W. Treating CTOs in the hybrid algorithm we use mostly as a step up approach Fielder XT, then Pilot 200, GLADIUS or GAIA family, then Conquest Pro 12 or Hornet 14. Mostly depending on the anatomic presentation of the CTO.

2017-10-02, 21h12
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Daniel W. Thank you all for the comments and the support

2017-10-02, 22h12
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evi supriadi S. good case, well done

2018-02-28, 5h12
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Mohamed M. Good

2018-05-06, 4h02
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Sarteep Ezzat Q. Thanks

2018-05-07, 23h57
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Mohamed M. Good

2018-05-11, 3h39
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Dirk P. Excellent result !
Learning point for me was the dilatation of the proximal cap with low profile balloon to facilitate the micro catheter. many thanks , Dirk P

2018-06-12, 6h06
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Khalid A. great results .. I would've saved some time using a guide extension to help with the Cx angulation . but nicely done .

2018-10-05, 19h48
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Hernan V. Exelent

2018-10-08, 22h41
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hashemi fard O. Excellent

2018-11-23, 23h51
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Usman K. Good case

2018-12-24, 20h46
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maher T. EXCELLENT

2019-01-03, 9h08
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A. https://www.google.com/

2020-05-13, 20h31
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A. good

2020-05-13, 20h32
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Dorin D. great job!

2020-06-20, 21h43
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CTO of proximal RCX

With blunt proximal cap

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Case summary

Description of procedure

Daniel Weilenmann

Anonymized

ASAI Gaia Second / Asahi

Across CTO / Acrostak

Resolute Onyx / Medtronic

Asahi Sion Blue / Asahi

ACROSS HP TM / Acrostak

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Suggestions

CTO of proximal RCX

With blunt proximal cap

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Case summary

Description of procedure

Join the Discussion

Suggestions

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