Скачать с ютуб Case 245: Manual of CTO PCI - Failed LCx CTO PCI в хорошем качестве

Case 245: Manual of CTO PCI - Failed LCx CTO PCI

A patient was referred for PCI of an ostial circumflex CTO. The CTO was located distal to a ramus branch with ambiguous proximal cap, length of approximately 20 mm, good quality distal vessel and filling via an epicardial collateral from the ramus. Coronary CT angiography showed severe calcification of the distal left main and the LCx origin. IVUS failed to clarify the location of the proximal cap due to calcification, but an estimation was made based on the CT angiography findings. Antegrade wiring attempts with various penetrating guidewires (including Gaia Next 3, Confianza Pro 12, and Hornet 14) failed despite using a Sasuke dual lumen microcatheter, a Venture and a SuperCross. We decided to go retrograde and successfully crossed into the distal obtuse marginal branch with a Suoh 03 guidewire. However, retrograde wire puncture failed: the retrograde guidewires entered into the extraplaque space around the left main. Due to risk of compromising the LAD and ramus with extraplaque crossing in the left main we decided to stop the procedure. The patient did not have any complications.