IVUS-Guided CTO intervention via TRI Escape from ‘False … · IVUS-Guided CTO intervention via...
Transcript of IVUS-Guided CTO intervention via TRI Escape from ‘False … · IVUS-Guided CTO intervention via...
IVUS-Guided CTO intervention via TRIEscape from ‘False lumen’
Presenter: Jeong Su KimOperator: Kook Jin Chun
Dept. of Cardiology, CV Center, PNUYH
Introduction
55yr male with accelerating Chest pain (CCS III)
Risk factor : Hypertension, Smoking
ECG : sinus rhythm, LVH with strain
Echo : EF 50%, basal inf. Wall hypokinesia
Unstable angina
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Left coronary angiogram
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Right coronary angiogram
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Strategy
OTW balloon + CTO-dedicated wire
Parallel or seesaw wire techniquewhenever indicated
IVUS-guided whenever indicated
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PCI at RCA
TRI: right radial
approach
6Fr. JR 4 Guiding
catheter
Runthrough G/W
(0.014 inch)
with 1.5 x 6 mm
OTW balloon
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PCI at RCA with Miracle 3.0g
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PCI at RCA with ConquestPro 12g
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PCI at RCA
ConquestPro with OTW balloon(1.5 x 6 mm)
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RCA F/U CAG
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RCA PCIwith parallel wire technique
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RCA PCI
Ballooning with 2.5 x 20 mm (ryujin)at p-RCA
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1st IVUS
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False lumen IVUS
False lumen
True lumen
IVUS: False lumen
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Penetration with Miracle 3.0 G/W
IVUS Catheter
False lumenTrue lumen
Miracle 3.0 G/W
2nd wire
IVUS guide parallel wire technique
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RCA F/U CAG
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Still goining the wrong way?
2nd IVUS
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Pre-PCI IVUS
True lumen
False lumen
False lumen
IVUS: true lumen
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RCA PCI
RCA os ~ p-RCA: Driver 4.0x30mmupto 18atm
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RCA PCI
m-RCA: Endeavor 3.5x18mmupto 18atm
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Final angiography
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IVUS after PCI
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IVUS after PCI
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* * * ** **
F/U CAGAfter 7 days After 1 year
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Summary
This case demonstrates
– Once a false lumen has been created, IVUS can
guide the wire to reenter into the true lumen.
– IVUS guided wiring technique is a safe and very
helpful technique to advance in a true lumen during
CTO intervention.
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