The Second Hospital of Jilin University, China
Scientific Tracks Abstracts: J Clin Exp Cardiolog
Statement of the Problem: Coronary chronic total occlusions (CTOs) are common during diagnostic angiograms. Comprehensive application of various strategies can improve the success rate. It is important to note that despite these advancements in techniques, CTOs remain difficult to treat. We present a case of left anterior descending artery (LAD) and right coronary artery (RCA) CTO that was successfully revascularized using complex strategy. Methodology & Theoretical Orientation: A 63-year-old man with two times of myocardial infarctions was presented with new onset angina and dyspnea at rest. Angiography showed that LAD and RCA CTO, proximal LCX had a serious stenosis. RCA PCI was attempted using an antegrade approach. This approach was unsuccessful due to branch vessel nearby the occlusion and the wire got into the branch repeatedly. As a result, we used a balloon to expand the entrance of the branch in order to extrude the CTO lesions, the wire gets through the occlusion and the RCA had a successful reperfusion. RCA supplied obvious retrograde vessels to LAD, but from the retrograde, the nub of CTO was flat and the wiring process failed. Then the strategy was changed from retrograde to antegrade. Retrograde wire showed a good milestone. Finally, LAD had a successful reperfusion. At follow-up, the patient was asymptomatic and returned to her usual activity. Conclusion & Significance: Side branch technique is an important method to antegrade strategy for CTO. Also, antegrade and retrograde should be used together to increase the success rate.