39 year old patient with mid-LAD CTO – successful IVUS-guided puncture of the proximal cap R. Schneider - HSK Wiesbaden Case Competition - 11th Experts Live CTO The annual Euro CTO meeting September 13th –14th, 2019 - Berlin, Germany

1. 11. Deutscher Allergiekongress 2016 in Berlin
39 year old patient with mid-LAD CTO –
successful IVUS-guided puncture of the
proximal cap
R. Schneider
HSK Wiesbaden

2. 11. Deutscher Allergiekongress 2016 in Berlin
Case presentation
 39 year old male patient
 Inferior STEMI 04/2019 – PCI RCA 3,5x15mm Xience
 CTO of the LAD
 Echo: LVEF 40-45 %, akinesia of the left ventricular apex
 MRI: good viability in the LAD territory
 Stable angina pectoris CCS 2
 Risk factors: smoking, family history

3. 11. Deutscher Allergiekongress 2016 in Berlin
Angio
 Ambiguous proximal cap
 Epicardial collateral from a big diagonal
branch
 No septal collaterals from RCA
 Decision for antegrade approach with IVUS

4. 11. Deutscher Allergiekongress 2016 in Berlin
Intervention
 IVUS: good visualisation of the
proximal cap
 Gaia 2nd and Confianza pro 12 failed,
successful puncture with Miracle 12
Wire
LAD

5. 11. Deutscher Allergiekongress 2016 in Berlin
Intervention
 Gaia 2nd and Confianza pro 12 failed,
successful puncture with Miracle 12
 Miracle 12 subintimal, successful
parallel wiring with Gaia 3rd
 Finecross, change to SION blue ES

6. 11. Deutscher Allergiekongress 2016 in Berlin
Intervention
 PTCA 1,2x20mm MiniTrek Balloon and
2,5x20mm Trek Balloon
 2,75x23mm Xience
 Good final result
Conclusion
In this case, IVUS helped to identify the
proximal cap of the CTO and led to a
good final result with complete
revascularization.