E-Science Station

Complex PCI - Chronic Total Occlusion
PCI of a Left Anterior Descending Artery CTO Through Left Internal Mammary Artery Graft
Harinder K. Bali1, Amreen Dhindsa2
Fortis Hospital, India1, Paras Hospitals Panchkula, India2,
[Clinical Information]
- Patient initials or identifier number:
-Relevant clinical history and physical exam:
73 years old maleKnown case of type 2 diabetes mellitus, coronary artery disease, had undergone CABG in 2007 with left internal mammary artery graft to left anterior descending artery and SVG to obtuse marginal. Presented with chest pain and shortness of breath for six monthsECG: Normal 2 D echo: NormalCT Coronary Angiography: patent SVG to obtuse marginal and patent left internal mammary artery graft with diseased left anterior descending artery beyond anastomosis 
-Relevant test results prior to catheterization:
- Relevant catheterization findings:
Retrograde filling of distal left anterior descending , patent left internal mammary artery graft with cutoff beyond anastomosis

[Interventional Management]
- Procedural step:
Procedure:                   PTCA+ stenting to LIMA→LAD.Route:                     Right Femoral ArteryContrast:                   Omnipaque Guiding Catheter:          6F XBC 3, ASAHIGuiding Wire:           BMW, ShinobiBalloon:                   Pre stent dilatation: 1.5x15mm, 2.0x15mm Stent:                   XIENCE XPEDITION SV 2.25x28mm XIENCE XPEDITION LL 2.5x33mm Balloon:                   Post stent dilatation done with 2.5x10mm balloon.Additional Drug:            Heparin 12,500 units.Additional hardware:      NilFINAL RESULT:              Successful PTCA+ stents to LIMA→LAD. 

- Case Summary:
To be successful in tackling a CTO lesion, one has to be proficient with the antegrade and retrograde approaches to CTO Antegrade  CTO-PCI of native coronary artery via LIMA grafts are rarely performed and few cases are reported world over.Our case demonstrates that the  PCI of a native coronary artery CTO via LIMA graft  is a feasible and safe option in patients with chronic total occlusions.
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