Successful recanalization of RCA chronic total occlusion with multiple BVS implantation

Case Summary

Demographics / CVRFs / Clinical presentation

74 years old malestable angina CCS IIIInferior wall inf. 2003PCI LAD 2009Unseccessful recanalization MB 2012Unseccessful recanalization RCA May 2014 - antegrade appr.

EKG / Non-invasive Testing

Small Q waves II, III, aVFHypokinesia of inferior wallEF 46%

Angiography / imaging

Initial Strategy ?

Antegrade appr. ?

Retrograde appr. ?

Others ?

A priori Retrograde approach

Step 1: Retro guidewire passage by III septal collaterals to occluded part RCAStep 2: Direct retrograde crossing or kissing wire crossing, externalization Step 3: IVUS/OCT guided BVS Implantation

Case strategy

Case Summary

Duration of the procedure: 190 min: Retro - > 2 h Ante – 30 min

Fluoroscopy time: 106 min

Total amount of contrast: 550 ml

Xr dose: 11510 mGy

Key learning points

Retro:

LCA: 7F EBU 4,0SionSion blueFielder XT, FCCorsair 150 cm

Key learning points

Ante:

RCA: 6F JR 4,0Sion + CorsairConfianza Pro 12 + Corsair

Mini Trek 1,20/12 mm-> Mini Track 2,0/30mm->Sprinter NC 3,5/27 mm

3 x Absorb 3,5/28 mm + 1 x Absorb 3,0/18 mm

Key learning points

Learning point 1: not everything visible is crossable

Learning point 2: switch for antegrade procedureshould be after 30 min unsuccessful guidewire penetrating ?

Learning point 3: antegrade wire-based strategy ofCTO-PCI is associated with high success rates after retrograde access failure…