Complex PCI - CTO
A Case of Retrograde CTO PCI
Gajendra Dubey1, Karthik Natarajan2
U N MEHTA INSTITUTE OF CARDIOLOGY AND RESEARCH CENTRE AHMEDABAD, India1, U N Mehta Institute of Cardiology & Research Centre, India2,
61 year old male patient named Mr U S.
Hypertension(5 years), Dyslipidemia( 5 years).
History of Inferior wall Myocardial Infarction 6 moths back. CAG done at outside hospital. Attempted PCI to RCA 2 months back(failed).
Current complaints- CCS-3 angina
Physical examination- Unremarkable
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Blood Investigations- Unremarkable
ECG- q waves in 2, 3, avF
Echo- EF-45% with RCA territory hypokinesia with preserved wall thickness
CAG showed totally occluded RCA and OM branches. There were epicardial collaterals from LCX to RCA. There were no visible septal collaterals from LAD to RCA.
Target Vessel – RCA(J-CTO-2)
Access- Right Femoral- 7F AL1. Right Radial- 6F EBU
Strategy- 1) AWE
2) Retrograde via possible septal collateral from LAD
3) Retrograde via epicardial collateral from LCX
•CTO PCI requires meticulousplanning and knowledge of hardware
•Familiarity with use of Antegradeand Retrograde approach increases the success of CTO PCI
•Calcium modifying tools are a must have in balloon uncrossable and balloon undilatable lesions
•Imaging helps in improving longterm success of CTO PCI