Author + information
- Chi Hong Chau1
Patient initials or identifier number
Relevant clinical history and physical exam
A 57 year-old female with history of Hodgkin's lymphoma status post radiation therapy of the chest wall, presented with chest pain and shortness of breath for 2 months. Physical examination of cardiovascular systems had unremarkable findings.
Relevant test results prior to catheterization
Nuclear stress test demonstrated moderate amount of ischemia in the distribution of PLV territory while echocardiogram revealed normal left ventricular systolic function.
Relevant catheterization findings
Coronary angiogram revealed radiation-induced calcified coronary artery disease with a functional chronic total occlusion at the ostial right coronary artery with left to right collateral's.
Initial antegrade wiring failed because of poor antegrade guide support secondary to anterior take off of the right coronary artery (RCA) and ostial calcification. Retrograde approach attempted in a separate procedure. The RCA was reached from the left anterior descending artery via septal collateral's with a series of wires. The aorto-ostial occlusion punctured by Confianza Pro wire, which subsequently switched to RG3 wire. The RG3 wire then snared in the ascending aorta into a JR 4 guide and externalized. 2 overlapping stents were placed in the RCA with excellent result.
Ostial chronic total occlusion is considered exceptionally difficult for percutaneous revascularization. The calcification in this case further complicates the procedure, making antegrade wiring impossible. We demonstrate an alternate approach by snaring and externalizing the retrograde wire followed by antegrade stent delivery.