Case 293: Manual of CTO PCI - Flush aorto-ostial RCA CTO скачать в хорошем качестве

Case 293: Manual of CTO PCI - Flush aorto-ostial RCA CTO

A patient was referred for PCI of a flush aorto-ostial CTO of the right coronary artery. There were prior stents in the mid RCA and the LAD. A primary retrograde approach was attempted. The LAD had focal in-stent restenosis that was successfully ballooned, followed by wire advancement into a septal branch. After predilatation of the septal origin (it was originating behind the prior LAD stents) a Turnpike LP was advanced into the septal. The septal was easily crossed with a Suoh 03 wire, followed by advancement of the microcatheter to the proximal RCA. Multiple attempts to wire into the aorta failed with the wire causing a small aorto-coronary dissection. Eventually a Confianza Pro 12 wire was advanced into the aorta and was snared by a 18-30 mm EnSnare. The wire came off the EnSnare in the guide catheter and was re-snared with a 2-4 mm EnSnare and externalized. An R350 wire was subsequently externalized and the proximal RCA was treated with balloon angioplasty, intravascular lithotripsy and stenting with a nice final result.