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High-Risk Intervention (diabetes, heart failure, renal failure, shock, etc) - High-Risk Intervention
Balloon Trapping Technique at the Antegrade Guiding Catheter Maybe Helpful if Gears Can Not Cross in CTP Retrograde Approach.
Dian Setiawan1, Wahyu Aditya2, Dian Larasati Munawar3, Muhammad Munawar3
Binawaluya, Indonesia1, Bina Waluya Cardiac Center, Indonesia2, Binawaluya Cardiac Center, Indonesia3,
[Clinical Information]
- Patient initials or identifier number:
-Relevant clinical history and physical exam:
A 64 years old femalecame to our hospital for progressive angina since 3 weeks before admission. Shehad history of  heart failure with lowejection fraction and better after we treated with optimal medical therapy.
-Relevant test results prior to catheterization:
Hb9.7  mg/dL  Hct28    %LDL73  mg/dl  HDL43 mg/dLTrigliserida171 md/dLcreatinine0.8 mg/dLureum24 mg/dLEDD52.6 mm/ ESD 48.1 mm, EF 16.3 %TAPSE2.2 cmRWMA(+) severehipokineticat basal Anteroseptal,Anterior, Apikoseptal,Hipokineticat other segment
- Relevant catheterization findings:
She had angiography which showed diffuse disease at left main (LM) with 50-70 % stenosis at mid to distal part, calcification at proximal part of left anterior descending artery with 90% stenosis, non significant stenosis of circumflex (LCX) and dominant vessel of right coronary artery (RCA) with CTO at proximal part, and retrograde filling from LAD to distal part through septal collaterals. 
[Interventional Management]
- Procedural step:
 CTO at the proximal RCA,ambigous of the proximal cap and long CTO lesion without calcification.Retrograde approach was successful using intimal retrograde wire escalationtechnique. Through septal channel,  retrograde wire can cross the CTO lesion andenter the antegrade guiding catheter. But the gears (microcatheter and smallestballoon) can not cross the lesion. Using balloon trapping technique at theantegrade guiding catheter, this technique give more support and finallyretrograde balloon and microcatheter can cross the CTO lesion. The CTO wassuccessfully performed and 3 drug eluting stent implanted with the good result. 
- Case Summary:
In retrograde approac, when wire cancross the CTO lesion and enter already enter in the antegrade guiding catheter,but gears can not cross, the trapping balloon technique may give additionalsupport in order the gears can cross. 
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