Case 291: Manual of CTO PCI - Accordioning скачать в хорошем качестве

Case 291: Manual of CTO PCI - Accordioning

A patient was referred for PCI of a proximal RCA CTO. The CTO had a blunt proximal cap that was located immediately proximal to the takeoff of a large acute marginal branch, length of approximately 30 mm, and diffusely diseased distal vessel that was filling via contralateral septal collaterals. Antegade wiring attempts failed, as the wires kept on entering into the acute marginal branch. A septal branch was successfully crossed with a Suoh 03 wire but the wire advanced towards the apex. The wire was pulled back and redirected towards the proximal right coronary artery. Retrograde wiring attempts were unsuccessful; the wire kept on entering into a bridging collateral. After multiple attempts a retrograde Gladius Mongo was advanced to the proximal RCA but antegrade wires and the BASE technique failed. After doing a retrograde Carlino a retrograde Gladius Mongo was advanced into the antegrade guide catheter, followed by externalization of an R350. The RCA was stented from the ostium to the PDA with a nice result. While retrieving the retrograde wire the antegrade catheter advanced deeply in the RCA causing “accordioning” of the proximal RCA stent (longitudinal stent compression). After restenting the proximal RCA a nice final result was achieved.