CASE20220818_003

Retrograde recanalization of CTO of the RCA

By Alexey Sozykin, Pavel Emelyanov, Alexandr Shlykov, Anatolii Larionov, Liudmila Ulyanova
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Presenter

Pavel Emelyanov

Authors

Alexey Sozykin1, Pavel Emelyanov2, Alexandr Shlykov1, Anatolii Larionov3, Liudmila Ulyanova2

Affiliation

Central Clinical Hospital of the Russian Academy of Sciences, Russian Federation1, Scientific Clinical Center 2 Petrovsky National Research Center of Surgery NRCS, Russian Federation2, Federal Cardiovascular Center Astrakhan, Russian Federation3
Complex PCI - Chronic Total Occlusion

Retrograde recanalization of CTO of the RCA

Alexey Sozykin1, Pavel Emelyanov2, Alexandr Shlykov1, Anatolii Larionov3, Liudmila Ulyanova2

Central Clinical Hospital of the Russian Academy of Sciences, Russian Federation1, Scientific Clinical Center 2 Petrovsky National Research Center of Surgery NRCS, Russian Federation2, Federal Cardiovascular Center Astrakhan, Russian Federation3

Clinical Information

Patient initials or Identifier Number

Gushin Ivan Andreevich

Relevant Clinical History and Physical Exam

A61-year-old patient was admitted with a diagnosis of coronary artery disease,angina pectoris, FC 3, HD III Anamnesis: considers himself ill since January2022. When I first began to notice the appearance of compressive, pressing painbehind the sternum.

Relevant Test Results Prior to Catheterization

Rbc – 4.2(N 4.2-5.6) Hgb – 113 g/l (N 131-172),  HCT– 38 (N 39-50), MCV – 90 (N 80-100),  MCH-30 (N 27-35), MCHC – 339 (N 320-360), PLT – 204 (N 150-400), MPV 7.9 (N 6-11), Lei – 5,5 (N 4-9),  RDW – 13.6 (N 11-14.8)

Relevant Catheterization Findings

Performed coronary angiography according to the following data:  LCA trunk throughoutthe stented area. LAD and LCX in the proximal segments were further stented with uneven contours. Calcification CTO of the RCA 

Interventional Management

Procedural Step

AL1 was placed at the ostium of the RCA, with the support of a microcatheter Corsair, the proximal operculum of the calcified ASB was successfully penetrated. Further, it was decided toperform retrograde recanalization of the RCA. Through the first septal branch,it was possible to bring the wire into the distal segment of the RCA. Escalated to the Gaia second wire and successfully penetrated the distal ASB cover. Further, extranalization was successfully performed using the Reverce CART technique, followed by predilation and implantation of 4 DES.

Case Summary

It is very important to estimate the complexity of CTO in advance, it isdesirable to evaluate CTO on several scales, since in this case the collateralnetwork is well developed, the PROGRESS CTO - SCORE scale was applied, whichincludes predictors of the hybrid CTO recanalization approach. Retrograde CTOrecanalization minimizes the risks of antegrade wires passing through thesubintimal space, and thus improves the long-term results of the intervention.