Antegrade approach to stumpless chronic total occlusion of ostial left anterior descending artery: first using a side branch cutting technique.
The approach to a chronic total occlusion (CTO) still remains one of the most technical challenges in percutaneous coronary intervention (PCI). CTO lesions with a blunt entry point, calcification, and failure of a previous approach, are the independent predictors of CTO-PCI failure. Here we report a successful antegrade approach for reattempted CTO-PCI of a left anterior descending artery (LAD) with unknown, calcified ostium. We used a novel side branch cutting technique, combined with intravascular ultrasound-guided wiring and parallel wire techniques. Considering the ramus artery as a side branch and dilating it with a cutting balloon was a crucial part of the strategy for achieving overall procedural success using this approach. This is the first report describing a side branch cutting technique in CTO-PCI. The combined application of multiple antegrade techniques, using the latest devices, might provide an effective and safe approach for complex CTO-PCI.
Department of Cardiology, Yue Yang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Jian
J
Dai
Osamu
O
Katoh
Eisho
E
Kyo
Takafumi
T
Tsuji
Satoshi
S
Watanabe
Hidefumi
H
Ohya
D000368:Aged; D002908:Chronic Disease; D054059:Coronary Occlusion / Q000601:surgery*; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000379:methods*