Author + information
- Chun-Yuan Chu1,
- Wen-Hsien Lee1,
- Po-Chao Hsu1,
- Hung-Hao Lee1,
- Cheng-An Chiu1,
- Ho-Ming Su1,
- Tsung-Hsien Lin1,
- Chee-Siong Lee1,
- Heueh-Wei Yen1,
- Wen-Chol Voon1,
- Wen-Ter Lai1 and
- Sheng-Hsiung Sheu1
Patient initials or identifier number
Relevant clinical history and physical exam
A 60 year-old female patient, presented with chest tightness after working in the morning on June 8, 2015.
Then she was sent to our ER
Other symptom : Cold sweating (+), Palpitation (+), Nausea/vomiting (-)
Past History: Hypertension , Hyperlipidemia
2-D echo: LVEF 54%, Mild MR and TR
Initially, PSVT was found at ER and sinus rhythm was restored after adenosine given intravenously. However, serial cardiac enzymes showed typical elevation and fall, NSTEMI was impressed and CAG was arrange after admission.
Relevant test results prior to catheterization
1st CAG was arrange in June, 2015 and it showed total occlusion of LAD after D1 branch and some collateral flow from RCA. Transradial approach with Ikari Left 3.5 Guiding catheter, Under a Strider microcatheter, Run through floppy,Runthrough Hypercoat, Fielder FC, UB3, Progress 140T were used but difficult to advance to distal LAD. Focal perforation and small amount pericardial effusion found. PCI stopped.
Relevant catheterization findings
2nd CAG was performed in June 2016.
Transfemoral approach with an 8F EBU 3.5 Guiding catheter, No obvious collaterals form RCA.
2nd PCI was perform with a Medtronic 8Fr EBU 3.5 guiding catheter via right femoral artery.
Under a Crusade microcatheter support, antegrade re-approach with an FC wire initially, then We successfully advanced a UB3 wire to distal LAD after carefully wiring.Serial POBA was performed with a Abbott Mini-Trek 2.0 x 20 mm, 6-12 atm, and then a NC euphora 3.0 x 15 mm, 16 atm for several times. IVUS showed that the UBS wire was in the true lumen with multiple calcified segments during tracing.Finally, a Synergy stent 3.0 x 38 mm was successfully implanted and IVUS confirmed good stent apposition.
Carefully plan Pre-PCI strategies always.
Use of a Crusade microcatheter could increase the back-up force and keep a coaxial position during wiring, and therefore, improve the success rate of Bifurcation-PCI and CTO-PCI.
Safety is of the highest priority.