Author + information
- Wei Chieh Huang1
Patient initials or identifier number
Relevant clinical history and physical exam
The patient had history of NSTEMI recently and received PCI. However due to long false lesion stunting, impaired LV ejection fraction was noted. Dyspnea was found and therefore he was admitted to our Hospital for further treatment
Relevant test results prior to catheterization
heart echo showed LVH, impaired LV systolic function and moderate to severe AS.Prior CAG showed long false stunting of RCA. PAD and PL branch showed total occlusion and with collaterals from LAD and LCX lesion.
Relevant catheterization findings
CAG showed RCA-P to -D was long false lumen stenting and -D: with total occlusion with good collaterals form LAD. LAD showed middle 80% stenosis with heavy calcification and LCX showed 40% stenosis.
For RCA lesion, a SAL GC was engaged to RCA lesion and initially we chose retrograde approach. A Sion GW under the support of F was used to punctured the RCA-D lesion. However, due to failure of crossing this lesion we upgrade our GW to Provia 12. Finally, we crossed this lesion and we used IVUS to elevate lumen. After successful advancing GW we stunting over RCA-D to PL and the final flow showed good TIMI III. Finally he was transferred to CCU for further treatment.
Stunting should only be done after confirmation of all/most part of wire in the true lumen, best by IVUS. Retrograde approach is the only way to reanalyze the occluded vessel with previous false lumen implanted stents.