Author + information
Patient initials or identifier number
Relevant clinical history and physical exam
(Case) 57 year-old Male.
(Present Illness) He was carried to our hospital due to AMI and culprit lesion of LCX sub total occlusion treated.
1 months later, PCI for RCA CTO performed.
(Coronary Risk Factor) Hypertension, Diabetes, Dislipidemia, Smoking.
Relevant test results prior to catheterization
posterior: Severe hypokinesis lateral-inferior: hypokinesis
EF=44%Coronary CT angio RCA total occlusion, calcification at proximal site of CTO
Relevant catheterization findings
LAD Seg 7) 90%
LCX Seg 14) 99%
RCA CTO with collateral from LAD Emergency PCI to Lcx performed with IABP support.
(System) RCA: Rt. radial a. 6/7Fr, LCA: Rt. femoral a. 6Fr
Guide catheters of 7Fr JL-4, AL1.5, AL-2, 6Fr IL-4 could not engage to RCA due to anomalous origin.
Finally, 6Fr JL-4 could get the RCA osmium
Antegrade approach: XT-R was advanced into CTO with Corsair
Despite of buddy wire and guide extension catheter support, the back up force of guiding catheter was too weak, therefore, we started retrograde approach.
Sion and Corsair passed septal channel and successfully externalized.
We implanted two drug eluting stents and achieved optimal recanalization
Appropriate assessment of vessel course by coronary CT angio.
Suitable choice of guide catheter.
Establishment of strong back up system with buddy wire, balloon anchor technique and guide extension catheter.
Retrograde approach and externalization.
These tips and tricks helped successful recanalization of RCA CTO with anomalous origin.