The Beauty of Retrograde CTO Wiring Technique to Rescue Complex and Complicated Lesions
Dr. Karl CHAN, Dr. Ken CHI
Prince of Wales Hospital, Hong Kong
48-year-old gentleman, ex-smoker, with strong family history of ischemic heart disease, presented with CCS class II. Exercise stress test was positive and formal echocardiogram showed normal LVEF. Initial invasive coronary angiogram showed severe stenosis with a complex plaque over distal RCA, significant stenosis over LAD and LCx. PCI to RCA with attempted yet failed to wire and complicated with hematoma (Movie 1, Movie 2). PCI to LAD and LCx was done smoothly.
Patient complains persistent CCS Class II symptoms after the Index procedure. Thus, another invasive coronary angiogram was arranged (Movie 3, Movie 4) and staged PCI to RCA was performed. Antegrade approach was attempted with Runthrough EF and Sionblack, yet failed due to previous multiple dissection planes (2 subintimal planes and only one true lumen right after the dRCA torturous bend) (Figure 1). Thus, retrograde CTO wiring technique was adopted to rescue. It was successfully wired retrogradely via septal channel with Souh 03 wire under Corsair pro micro-cathether support (Movie 5); and stented with DES smoothly with excellent final angiographic results (Movie 6, Movie 7).
Learning Point:
The beauty of retrograde CTO wiring technique to rescue complex and complicated lesions.