Рет қаралды 2,591
A patient was referred for PCI of a left main CTO after experiencing recurrent failure of a saphenous vein graft to the ramus. The CTO had a blunt but clear proximal cap, length of 20 mm, a bifurcation at the distal cap (ramus and circumflex) with the ramus filling via a SVG that had recurrent restenosis. Antegrade wiring with a Hornet 14 resulted in extraplaque wire position. After balloon angioplasty of the restenotic segment of the SVG a Gaia Next 3 wire successfully crossed the CTO into the proximal true lumen and was advanced into the antegrade guide catheter. After wire externalization the left main CTO was predilated and stented into the LAD but the stent was severely under-expanded. Intravascular lithotripsy was not successful in expanding the stent but a SIS-OPN balloon was successful at 45 atm. The ostium of the circumflex became compromised with a dPR of 0.34. The circumflex was predilated and stented using the culotte technique with a nice final result. In the end the SVG to the ramus was occluded with a combination of an Amplatzer vascular plug and a Penumbra packing coil.