A Case of Complex CTO

By Raman Chawla
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Raman Chawla


Raman Chawla1


Caremax Superspeciality Hospital, India1
Complex PCI - Chronic Total Occlusion

A Case of Complex CTO

Raman Chawla1

Caremax Superspeciality Hospital, India1

Clinical Information

Patient initials or Identifier Number


Relevant Clinical History and Physical Exam

A 80years old male presented with  c/o chest pain  for duration of  3dayschest pain radiating to back andshoulder ,chocking sensation on exertion , pain aggravates on minimumexertion or effort , angina for 2years ,breathlessness gradual in onsetprogressive in nature , grade II NYHA, history of  pnd +, patient is  non diabetic and  hypertensive on regular medicine O/E vitals within normal  limits R/s: crtepts  Cvs 1 s2 heard Cns: normal 

Relevant Test Results Prior to Catheterization

Lad : Mild PlaquingLcx : SmallNon-Dominant Vessel With 95 % Disease DistallyRca : LargeDominant Vessel. Diffuse Calcific Disease In Proximal And Mid Segment F/BSubtotal Occlusion With Timi-Ii Antegrade As Well As Retrograde Filling FromLad Collaterals  

Relevant Catheterization Findings

Interventional Management

Procedural Step

10 year old ctobe ready for failure even after crossing the wire Require different techniquesfor crossing the wire Anchor balloon technique is excellent technique but don’tbe stupid as i was Once you have broken balloon in guiding like this you haveto pray and act intelligently So called balloon                      embolectomy is possible.Bewareof hard and non dilatable lesions.Pre-dilation 1.5x10mm  balloon could not be advanced Guideliner(6fr) used , but with no success    Buddy wire used in addition, butballoon  could not be advanced Check injection revealed ostial dissection ofrca3 × 13 des deployed and timi-iii flow achieved.after engagementwith al-1 predilation attempted but again failed in crossing the lesson Crossinglesion again required guideliner Serial dilations with 2.5 × 9 nc balloon given.

Case Summary

One of thefailure for cto intervention is inbaility to cross with  balloon or stentsMultiple techniquesare available for diffcult crossingThis casedemonastrates      Guideliner      Buddy wire      Anchor balloon       Exchanging the guide on crossed ptcawire