Author + information
- Shozo Ishihara1
Patient initials or identifier number
Relevant clinical history and physical exam
Case: 71 years old. Male
CABG (SVG-LAD, SVG-LCx) 10 years ago
PCI (DES in RCA see 2) 1 year ago
Present illness: Follow up CAG after RCA PCI showed SVG-LCX occlusion and we found the ischemia of LCx territory by stress RI test.
So 3 months later, he was hospitalized to receive PCI for LCx-CTO
(Coronary Risk Factor)
HT(-), HL(+), DM(+), smoking(-)
Relevant test results prior to catheterization
Ischemia of LCx territory by stress RI test
Relevant catheterization findings
LAD: Total occlusionLCX: total occlusionSVG to LAD: patentSVG to LCX: occluded
System and Guiding catheter: Bi-radial approach (with 6/7Fr Glide sheath)
Antegrade: 7Fr EBU-3.75 SH
Retrograde: 7Fr AL-1 (via SVG)
Antegrade guide wire crossing seemed so difficult that we started retrograde approach.
There were no suitable collateral channel for distal LCX, therefore, we tried to cross the occluded saphenous vein graft (SVG).
Fortunately, the guide wire reached to the distal end of CTO and reverse CART performed.
After the successful externalization with guide extension catheter, two drug eluting stents were implanted.
Good antegrade coronary flow obtained without any complications.
Case summary: GW passed to distal truelumen successfully by bi-radial approach via occluded SVG and Reveres CART technique with guide extension catheter.
Conclusion: In a situation of no suitable collateral channel, occluded bypass graft might be a good option for retrograde approach.