Imre Ungi "Клинический случай"

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  • Imre Ungi "Клинический случай"

    1. 1. Retrograde recanalization of an eight year-old ostial LAD CTO Imre Ungi, MD, PhD Szeged, Hungary
    2. 2. Clinical History <ul><li>67 year ♂ , hypertension, hypercholesterolemia, smoking; </li></ul><ul><li>2002 : stable angina pectoris, no MI in the history; </li></ul><ul><li>Bicycle stress test : ST depression in V 2-6 leads; </li></ul><ul><li>Coronary angiography : Ostial LAD occlusion, </li></ul><ul><li>Collaterals from the RCA; </li></ul><ul><li>Medical treatment, stable angina (CCS 2) for several years. </li></ul><ul><li>2008-09 : progressive angina (CCS 2->3); </li></ul><ul><li>Stress SPECT : large anterior wall transient ischemia. </li></ul><ul><li>Echocardiography : good LV function; </li></ul><ul><li>Coronary angiography : no major change since 2002. </li></ul><ul><li>Therapeutic decision: optimization of medical treatment </li></ul><ul><li> -> no improvement -> </li></ul><ul><li>CABG was recommended, but refused by the patient. </li></ul>
    3. 3. Coronary angiogram prior to LAD CTO recanalization Left coronary angio Caudal-LAO Right coronary angio RAO
    4. 4. Retrograde approach from the RCA through septal collaterals Corsair in the 2 nd posteroseptal branch Selective septal angio through the Corsair catheter
    5. 5. Retrograde approach from the RCA through septal collaterals Passage of Corsair catheter with retrograde anchoring Left coronary angiography, CaLAO
    6. 6. Retrograde approach from the RCA through septal collaterals Retrograde penetration of the distal cap Introducing the retrograde wire into the guiding catheter
    7. 7. <ul><li>POBA in the occlusion with antegrade balloon on the externalized wire </li></ul>POBA with the antegrade balloon in the occluded segment Antegrade angiography
    8. 8. <ul><li>Angiography and stenting of the LAD </li></ul>Deployment of the distal stent Into the bifurcation LAD lesion Proximal stent deployment
    9. 9. <ul><li>Stent jail of the intermediate artery and RCX </li></ul>Kissing balloon of the RCX jail Coronary angiography Cranial AP
    10. 10. <ul><li>Final result </li></ul>Left coronary angiography Caudal AP Simultaneous final coronary angiography
    11. 11. <ul><li>Six-month angiographic follow-up </li></ul>Left coronary angiography Lateral view Left coronary angiography Cranial AP
    12. 12. Conclusions <ul><li>Blunt ostial CTO of the LAD is one of the most challenging type of coronary lesions; </li></ul><ul><li>Retrograde passage from the RCA to the LAD through septal collaterals may be difficult even with Corsair, but can be facilitated with anchoring; </li></ul><ul><li>Externalization of the retrograde wire significantly improves the success rate in case of impossible antegrade wiring; </li></ul><ul><li>Synergism between different techniques and devices can be the key of the successful recanalization in challenging CTO cases. </li></ul>

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