Author + information
Patient initials or identifier number
Mrs J. 50 years old lady
Relevant clinical history and physical exam
Presented to us with shortness of breath during activity and was progressive within 1 year. She had Hypertension and Dyslipidemia with no history of previous myocardial infarction. Her father had history of coronary artery disease.
Relevant test results prior to catheterization
ECG sinus rhythm q wave in anteroseptal region. Exercise stress test was positive. Echo revealed anteroseptal, inferoseptal and septal hypokinesia with EF 47%.
Relevant catheterization findings
Coronary angiogram showed Tight LM disease with heavily calcified ostial CTO LAD and LCx. RCA non significant stenosis with collateral to LAD and LCx.
High Risk percutaneus coronary intervention performed using Run through NS hyper coat with Micro catheter support as an effort to cross CTO LCx lesion. Multiple predilatation then was performed with NC balloon 2.0 x 20 mm after the guide wire succeed crossing the CTO lesion. Further, predilatation at LM-ostial LCx to make plaque modification and then create origin LAD. Then we managed to cross the CTO LAD lesion using Run through NS hyper coat guide wire with Micro-catheter support . Multiple predilatation then was performed with NC balloon 2.0 x 20 mm distal to proximal LM. Finally, we use Tap technique for this bifurcation lesion, deployed DES Coroflex ISAR 3.5 x 12 mm at LMCA-LAD, rewire LCx and deployed DES Coroflex ISAR 3.0 x 27 mm at LMCA-LCx. Then we performed Kissing Balloon to 8 atm. The final result showed good TIMI flow III, no residual stenosis.
It has been reported a successful PCI to Protected Left Main disease and heavily calcified double CTO using simple wire or hydrophilic wire. Sometimes we need to do Plaque modification or debulking to create origin of native arteries. Procedure was performed successfully without complication and good clinical condition.