Challenging CTO-Dense Calcium at entry and exit: An interesting BRS case

1. CHALLENGING CTO- DENSE
CALCIUM AND BIFURCATION AT
ENTRY AND EXIT:An Interesting BRS
Case
DR DHARMENDRA JAIN
DM (CARDIOLOGY),
FNB(INTERVENTIONAL CARDIOLOGY),
FACC,FESC,FSCAI,FISC,FICC
ASST. PROFESSOR CARDIOLOGY,IMS,BHU,VARANASI
djaincard@gmail.com

2. CLINICAL HISTORY
• 58 YR MALE H/O AOE II –III 2YR
• NONHYPERTENSIVE , NONSMOKER, TYPEII
DIABETIC
• CAG 2YR BACK S/O LAD PX 100% WITH DENSE
CALCIUM FILLIN RETROGRADELY FROM RCA
• PCI IST ATTEMPT TO CROSS CTO FAILED
BIFURCATION AND DENSE CALCIUM AT ENTRY

3. STRTEGY OF REVASCULARISATION
AND EQUIPMENTS USED
• SUCCESSFUL PCI 2ND ATTEMPT AFTER CT CAG
GUIDANCE TO FIND THE TRACKS AMONG
CALCIFIC CHUNKS
• GRADUAL UPGRADATION OF CORONARY
WIRES GAIA IST THEN GAIA 2ND THEN
CONQUEST PRO12 WITH CORSAIR SUPPORT

4. CAG
https://youtu.be/_OviaaTO00A

5. CAG

6. CAG

7. CT: dense calcium at entry and exit of CTO

22. GAIA FIRST WIRE - CORSAIR

23. WIRE SLIPPING IN D1- GAIA II FAILED

24. CONQUEST PRO 12-BIFURCATION AND
CALCIUM AT DISTAL CAP

25. • DISSECTION AFTER WIRING : BIAS OF TRUE
LUMEN : CONFIRMED FROM RCA AND
CORSAIR INJECTION FINAL GOOD BED FOR
BRS AND GOOD END RESULT WITH TIMI III
FLOW.

26. PROGRESS OF CORSAIR – CORSIR
ANGIO

27. PROGRESS OF WIRE-?TRUE LUMEN

28. CORSARE ANGIO-ANGIO VIA GUIDE

29. ISSUE OF TRUE LUMEN?-WIRE IN
SEPTALS

30. PREDILATION -RESULT

31. PREDILATION 3X24-POSITIONING
STENT

32. Post bvs deployment --postdilation

33. FINAL RESULT

34. FINAL RESULT

35. LEARNING POINTS
• PREPARING APPROPRIATE BED BEFORE BRS
DEPLOYMENT IS THE KEY TO SUCCESS IN SUCH
DENSELY CALCIFIED CTO LESIONS WITH
BIFURCATION AT ENTRY.

36. THANK YOU