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Complex CTO-PCI: Japanese Approach
Live Case Demonstration of Antegrade-Retrograde PCI of Complex RCA CTO
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Dr. Etsuo Tsuchikane
Dr. Etsuo Tsuchikane
October 31, 2017 -- Tokyo, Japan -- The video below shows a complex CTO case, in which the RCA obstruction, complicated by a sharp bend and tortuous anatomy, was revascularized using both the antegrade and retrograde approaches. This case was broadcast live during the Japanese CTO Club course in June 2017.

The patient is a 50-year-old male with a totally occluded mid-RCA. Because of the complex anatomy (severe bending, mild calcification, and a contrast stain in the RCA) the initial hospital was unable to cross the lesion and referred the patient to Toyohashi Heart Center (Aichi Japan) and Dr. Etsuo Tsuchikane.

Because of the potential of a perforation, Dr. Tsuchikane decided to utilize a retrograde approach following the antegrade preparation, since a perforation, if it occurs, is less critical when made by the retrograde guidewire than by the antegrade guidewire. This extremely challenging case utilized a septal branch to deliver a guidewire retrograde via the left coronary system, while placing the drug-eluting stents via the antegrade approach. To accomplish this required high quality biplane angiography, IVUS intravascular imaging, and a variety of guidewires.

The video case below is provided by our Japanese partner, TCROSS NEWS, and made possible by Shimadzu Medical Systems.

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Antegrade-Retrograde PCI of Complex RCA CTO


Reported by Burt Cohen, October 31, 2017