IVUS Guidance PCI Using Drug Elution Balloon for RCA CTO

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72-year-old

Dx: 1.Coronary artery disease with triple vessel disease s/p PTCA/DEB to RCA-M CTO 2. Type 2 DM 3. Hypertension 4. Hyperlipidemia 5.
Transient ischemie attack
CC hest tightness over the past two months

Coronary CTA revealed a coronary artery calcium score of 221.6 ; RCA CTO

Date: 2025,07, 30Procedure: CAG + LH + PCI
Approach: RICA approach via right radial artery; LMCA approach via left radial artery
Contrast: 180 ml Ultravist
CAG: LM: mild calcification with luminal irregularity
LAD: LAD-P to LAD-D diffuse artherosclerosis with 50-70% stenosis
LCx-p, LCx-d diffuse artherosclerosis, OM2 80% stenosis, acute marginal collateral to PL OM,
collateral to PA, RCA: RCA-M total occlusion with bridging collateral to RCA-D syntax score: 18
Diagnosis: CAD with 3VD s/p PC for R CA-M
PC note: Target lesion: RCA-M GC: ALO. 75 7Fr Gw: runthrough, UB3, Gaia 2nd
Balloon: 25 x 15 mm TREK, inflated 14 atmi 2.0 x 15 mm MINI TREK, inflated 14 atm: 4.0 x 20 mm
Emerge, inflated 8 atm; DEB: B. braun (Melsungen AG 4.0 x 40 mm, inflated 16-18 atm Special devices: corsair pro 135 cm, Sasuke double lumen catheter, IVUS(indication: long diffuse and CTOl
Engaged RCA using AL0.75, 7Fr. Advanced runthrough with navigation of corsair pro 135 cm.Wire escalation to UB3. Antegrade angiography showed no reflow. Engaged LIVICA using JL3.5 5Fr via left radial artery. Contralateral angicanpany showed the wire was not in the true lumen.
Withdrew corsair pro 135cm using 25 x 15 mm TREK balloon at 14 atm. Parellel wire technique with advanced runthrough with navigation of corsair pro 135cm. Wire escalation to Gaia and.
However, subintimal approach was noted. Parellel wire technique using sasuke double lumen catheter and finally the UB3 was advanced through the CTO cap to distal RCA and wire was in true lumen by contralateral angiography. Withdrew sasuke double lumen catheter using 25 x 15 mm TREK balloon and advanced corsair pro 135cm to distal RCA. Antegrade tip injection showed the tip was in the true lumen. Shifted wire to runthrough, Withdrew corsair pro using 25 x 15 mm TREK balloon at 14 atm. Dilated the lesion using 2.0 x 15 mm MINI TREK balloon at 12-14 atm. IVUS was performed which showed the luminal diameter was about 4.0 mm with rich of plaque burden. Dilated the lesion using 4.0 x 20 mm Emerge ballcon at 14 atm. Due to recoiled: 2086, we deploved B. braun Melsungen AG 4.0 x 40 mm DEB at 10 at for 1 minute and 30 seconds. The final result was optimal.
Categoria
Cardiology
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