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Patient initials or identifier number
Relevant clinical history and physical exam
We present a case of 70 years-old male, diabetes,
with history of stable angina pectoris CCS III.
He was presented for scheduled staging elective PCI.
He had a history of 1 DES implantation at RCA one month earlier
Physical examination was unremarkable.
Relevant test results prior to catheterization
The ECG showed pathological Q wave in lead II, III, AVF,V1-V4,
Echocardiography with 45% ejection fraction and hypokinetic at anterior segment.
Renal function was normal.
Relevant catheterization findings
The angiography of radial artery showed 70% stenotic.
Coro-angiography showed large normal LM with aneurism.
LAD had 60-80% multiple stenotic with post-stenotic dilatation at proximal part, and 70-80% long lesion at distal part.
LCx had total occlusion at proximal part with distal part get collateral flow from ipsilateral.
The 7Fr sheath was used to replace 6Fr sheath in radial artery. 3,5/7Fr XB Guiding catheter was inserted into radial artery lumen with balloon assisted tracking technique then successfully cannulate LCA. We used Fielder XT-A to cross the lesion in LAD since floppy wire could not across the lesion. We predilate lesion in distal to proximal part of LAD with 2.0 x 15 mm Ryujin balloon. We deployed Resolute Integrity 2.25 x 30 mm 9 atm at distal LAD. LCx CTO was successfully crossed with Gaia 2nd wire since Fielder XT unable to cross the lesion. We pre-dilated proximal to distal LCx with Ryujin 2.0 x 15 balloon 12 atm. We placed Resolute Integrity 3.5 x 34 mm at Proximal LAD and Resolute Integrity 2.75 x 26 mm at proximal LCx and then both of stents was deployed simultaneously with V-stenting technique 12 atm at LAD and 18 atm at LCX. Kissing balloon post dilatation technique was performed with 4.0 x 15 mm NC balloon at LM-LAD and balloon stent at LCx 12 atm simultaneously. The Final good angiography result with TIMI 3 flow was achieved.
• Strategy of intervention will determine the access route consideration
• Radial access have its convenience for both patients and operator
• Many procedure of complex PCI can be performed by transradial approach
• A must-learn technique to overcome radial problem is very necessary
• Well-equipped Logistic preparation is mandatory