# ICMP (EF=53%) # STEMI (inf MI) s/p PCI at p to dRCA (Resolute 4.0-34mm + Promus 3.5-38mm 2013.7)   75/M, he visited OPD, taking no medicine during 15 days, without additional procedure for LAD CTO following RCA STEMI PCI around 10 years ago.
2023년 김재문 1st PCI03.wmv
2023년 김재문 1st PCI12.wmv
2023년 김재문 3rd PCI07.wmv

BUN/Cr 15.4/1.0Troponin T/CK-MB 0.017/2.23WBC 6100 Hb 16.0 PLT 214KHbA1c 7.6%

LM bifurcation 1-1-1, LAD CTOJ CTO 4 points : calcification 1, blunt 1, bending > 45 degree 1, 20mm이상 1* antegrade approach *Wire ; Corsair Pro -> Supercross 90degree assisted Runthrough -> Fielder XT-A -> Gaia next 1 -> Conquest Pro 12 failed to pass
2023년 김재문 3rd PCI06.wmv
2023년 김재문 3rd PCI11.wmv
2023년 김재문 3rd PCI03.wmv

1st CAG* Retrograde approach *   Finecross assisted Runthrough -> SUOH03 -> UB3 -> Miracle 12 -> Conquest Pro 12 -> Gaia 3rd next -> Astato 30 failed to pass   * R-CART *   Antegrade : Runthrough with NEON 2.5-15mm upto 6-14 atm & retrograde Finecross assisted Fielder XT-A -> Miracle 12 -> Conquest Pro 12 -> Gaia 3rd next -> Astato 30 -> Fielder XT-A finally passed into LM   •Randezvous *   Due to relatively short length of retrograde Finecross, antegrade Coquest pro assisted Fielder XT-A successfully passed inside retrograde Finecross in left main vessel   -> Under microcatheter Randezvous, microcatheter failed to advance through antegrade approach (d/t very calcified plaque)   -> Ballooning : Ryurei 1.0-5mm upto 14 atm but failed to pass -> Ikazuchi 1.5-10mm upto 14 atm at but failed to pass     •Snaring *   Through antegrade approach, following RG3 randezvous, it failed to advance more near by RCA catheter -> Snaring RG3 wire outside of RCA vessel RG3 failed to perform due to stucked RG3 wire inside microcatheter   -> Antegrade Turnpike gold also failed to pass   2nd CAG• balloon mini-crushing 2 stent technique for LM bifurcation *
3rd CAG   * Antegrade preparation *   Finecross asissted Runthrough into pLAD     * Via retrograde approach into GC (EBU 3.5) & extenalization through calcium neglect strategy *
2023년 김재문 1st PCI03.wmv
2023년 김재문 3rd PCI04.wmv
2023년 김재문 3rd PCI14.wmv

Balloon uncrossable cto
1. Daughter catheter + 1.0 balloon2. SB anchoring + 1.0 balloon3. 7, 8 Fr strong GC back-up4. Tornus5. Bougination and balloon advancement with Parallel CTO wire, 6. Under pushing upto the front of lesion with microcatheter,  rota wire passage and rotablation7. Retrograde approach attacking distal cap 8. Cutting effect technique taking turns of ballooning with another single wire 9. Calcium neglect strategy 10. Dual lumen catheter 11. Retrograde knuckle wire