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Patient initials or identifier number
Relevant clinical history and physical exam
The patient was an 85 year-old male who presented with lack of appetite and chest discomfort. He had a history of hypertension and dyslipidemia. As blood tests showed elevated CK levels and the ECG displayed ST depression in I, aVL, V1, and V5-6.
Relevant test results prior to catheterization.
Relevant catheterization findings
He admitted to our hospital and a coronary angiography was performed for suspicion of unstable angina. A chronic total occlusion was revealed in the ostial LAD segment 6, and severe stenosis from the LMT to segment 11 of the LCx. As the patient judged to be at high risk for CABG due to a history of unruptured cranial aneurysm and after-effects of cerebral hemorrhage, PCI was performed.
The 7Fr Glide sheaths were inserted from both radial arteries, and the procedure was begun by using 7Fr guiding catheters. The retrograde approach was first attempted but difficulty was metin crossing the wire, so we switched to the antegrade approach and using the reverse CART technique, we successful crossed the retrograde wire. Next, using the SYNERGY stent (3.0 × 24 mm) and the Ultimaster stent (3.0 × 24 mm) for segments 6 and 11, culotte stenting and KBT were performed. Two Xience Alpine stents(2.25 × 28 mm ＋2.5 × 38 mm) were then successively placed from LAD segments 7 to 8, and procedural success was achieved.
Here, we describe our experience in a CTO patient with a high SYNTAX score on whom we were able to conduct minimally-invasive PCI from the bi-radial approach using a 7Fr guiding catheter through the use of a 7Fr Glide sheath.