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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
Date du tournage : 27/06/2016
Dernière mise à jour : 03/08/2017
Dernière mise à jour : 03/08/2017
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Suggestions
Very complex Mid RCA occlusion
Retrograde in 1st intention and Antegrade approach for recanalization
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Instent proximal circumflex occlusion with bridging collateral
Antegrade parallel wire technique
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Kare T. Should you be more careful with antegrade injection due to risk of hydronic dissection?
Olaf R. why did he not change again to fielder XT again after penetrating the proximal cap with a stiffer wire?
Ayman T. i think Sion blue was used to deeply engage LCX
Ayman T. very useful
Umar S. Well done great job
Stefan H. Congratulations, nice procedure!
Raisakis K. Nice
Zambonialbe A. Well done!
Aquilina M. Which kind of wire do you use?
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.
Daniel W. Thank you all for the comments and the support
evi supriadi S. good case, well done
Mohamed M. Good
Sarteep Ezzat Q. Thanks
Mohamed M. Good
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
Khalid A. great results .. I would've saved some time using a guide extension to help with the Cx angulation . but nicely done .
Hernan V. Exelent
hashemi fard O. Excellent
Usman K. Good case
maher T. EXCELLENT
dow R. https://www.google.com/
dow R. good
Dorin D. great job!