Complex PCI - Chronic Total Occlusion
Anna Katrina Chua1, Ronaldo Estacio1, Jhoanna Marcelo1
Philippine Heart Center, Philippines1
A 61 year old male ,hypertensive,diabetic , non compliant to medications, with history of stroke with left sided residuals, 50 pack year smoker and previous heavy alcoholic drinker .He presented with severe, substernal chestpain 8 hours prior to admission accompanied by shortness of breath and diaphoresis. Managed as a case of STEMI of Inferior wall, in Cardiogenic Shock, with Ventricular tachycardia.Synchronized Cardioversion and ACLS was done an patient was transferred in PCI capable institution.
12 L ECG ST elevation leads II, III, aVF ( inferior wall) V3R V4R ( RV extension) and V7 , V8 ( Posterior wall)
Tip in technique is done by advancing the antegrade microcatheter over the retrograde guidewire in the antegrade guide, allowing easy, predictable, and successful antegrade wiring by inserting a wire into the antegrade microcatheter which allows successful revascularization of a CTO after failure to externalize. Advantages include decreased risk of vessel injury, decreased risk of donor vessel ischemia, decreased risk of bleeding and decreased risk for wire entrapment .