Author + information
- Haeng Nam Park1
Patient initials or identifier number
Relevant clinical history and physical exam
He had a past history of inferior old myocardial infarction, old cerebral infarction and old cerebral hemorrhage.
He admitted due to syncope this time.
His consciousness level was clear. BP was 98/67 mmHg. Coarse crackle could be ausculated. SPO2 was 95% under 2L O2 support.
Relevant test results prior to catheterization
ECG revealed sinus tachycardia and abnormal Q wave in II, III, aVF and V4-6.
UCG revealed diffuse severe hypokinesis. EF was 25%
Chest X ray revelaed CTR enlargement and mild pleural effsuion.
Laboratory data revealed Trop I and CK-MB were elevated and mild renal dysfunction.
CT revealed total occlusion of Rt. common carotid artery.
Relevant catheterization findings
LAD #7 subtotal
LCX #11 subtotal s/o, #13 CTO #11 just was very large vessel diameter.
RCA #1 90%, #HL 90%
We performed PCI via femoral approach. Wechose 7F backup type guiding catheter. According to angiogram of pre procedure,there seemed to be micro channel in proximal CTO. We used Sion wire with Caravel at first. But Sion could not advance into proximal CTO. So we changed the wire to XTR. XTR could advanced into proximal CTO. But Caravel prolapsed toward LAD because just proximal part of LCX was very large diameter.Fortunately, XTR advanced into small OM branch of distal part of proximal CTO. We dilated with 1 mm balloon, then Caravel advanced to the lesion between two CTO. XTR could pass through distal CTO, but Caravel, old and new 1 mm balloon could not advance into distal CTO. Therefore, we dilated proximal CTO with 2 mm balloon and inserted guideliner into proximal CTO. Then 1 mm balloon could pass distal CTO, and we dilated 1 and 2 mm balloon subsequently.
Finally, 1 DES was implanted in proximal LCX.
We performed PCI to complex lesion of CTO including double CTO with large ostium of LCX.
It was difficult to manipulate wire and cross micro catheter because devices prolapsed toward LAD easily.
But by using double lumen catheter and guiding catheter extension tool, we achieved successful PCI.