JIM Today 2018 - Saturday - page 1

24 February 2018
selection of live cases were presented
on Thursday afternoon at JIM, with
Eberhard Grube, Georg Nickenig and
Nikos Werner (University Hospital
Bonn, Germany) joined by guest op-
erators Paul Hsien-Li Kao (National Taiwan Univer-
sity Hospital, Taipei, Taiwan) and Marco Wainstein
(Hospital de Clínicas de Porto Alegre, Brazil).
Retrograde PCI of LAD CTO
Dr Grube presented the session’s first case of a ret-
rograde PCI of chronic total occlusion (CTO) of the
left anterior descending (LAD) artery, in 51-year-old
male patient with risk factors including arterial
hypertension, hypercholeserolemia and smoking.
Past medical history included previous two-vessel
coronary artery disease (08/2017, primary PCI
RCA (STEMI); 01/2018, retrograde PCI LAD CTO
attempt)), ventricular fibrillation (09/2017, ICD
implantation) and atrial fibrillation. The patient was
presently admitted to hospital with angina pectoris
CCS III, with J-CTO score of 3.
Angiography identified two-vessel coronary
artery disease (CAD), consisting in LAD occlusion
from the ostium on, with patent right coronary
(RCA) after PCI last year, mildly impaired left ven-
tricular function (ejection fraction 53%). Nuclear
scan after physical exercise was positive.
The team decided on a procedural strategy of
retrograde PCI of the LAD CTO. A bifemoral ap-
proach was adopted with 8 F guides going into the
RCA and LCA. A 20-25 mm CTO was noted by Dr
Kao, as well as disease presence distal to the CTO
cap. The presence and viability of several septals
was noted, although septal passage was unsuc-
cessful during previous retrograde PCI attempt.
A 150 cm FineCross micro catheter (Terumo,
Japan) with Sion guidewire (Asahi Intecc, Japan)
was positioned within a candidate septal ves-
sel. The wire was advanced in the LAD, although
the FineCross could not be advanced and so was
replaced with a 135 cm Corsair pro (Asahi Intecc).
Hence the septal channel was dilated sufficiently to
then manoeuvre the FineCross across.
“You were using a FineCross at the beginning,
so why not just use a Corsair Longline to do that
rather than switching several times?” Panel mem-
ber Dr Yeung asked.
“We had a discussion about this,” acknowl-
edged Dr Kao. “Actually the pushability of a
150-cm Corsair is much worse than a 135-cm. If
you were to use a 150-cm, maybe you would not
pass. Turnpike [Vascular Solutions, MN, USA] is
also a good choice. But FineCross is also cheaper
in Taiwan!”
“There are going to be new and interesting
microcatheters being developed,” added Dr Leon.
“Boston Scientific [USA] has the Mamba, which
people are starting to get some experience with. I
think we are going to see major changes in micro-
The official
of the Joint
A tale of two
TAVI valves
GPIs in
high-risk ACS
Calcium: how can
imaging help?
Emblok cerebral
Live cases
planning in
CTO and
mitral VIV
“Not every hospital
has these expert
CTO operators.”
Martin B Leon
Continued on page 2
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