TCTAP 2015

I, Made Junior Rina Artha, DO NOT have

a financial interest/arrangement or

affiliation with one or more organizations

that could be perceived as a real or

apparent conflict of interest in the context

of the subject of this presentation

TCTAP 2015

Introduction

• Chronic total occlusion (CTO) of coronary arteries is one of the most challenging percutaneous coronary intervention (PCI)1

• CTO make about 20 % of all coronary lesions, only 7-15 % were treated with PCI1

• Long lesion, severe calcification was a factors influencing the success of CTO interventions

• Complication of CTO PCI : coronary or non coronary, antegrade or retrograde 2

1. Christofferson RD, et al. Am J Cardiol 2005; 95, 1088-1091.

2. Nathan Lo, et al. JACC 2014; 7, 47-54

TCTAP 2015

Case

• Male, 67 yo

• Stable Angina Class II

• RF : Hypertension, DM

• ECG : NSR

• Echo : Global Normokinetic, LVEF 64 %

TCTAP 2015

Severe calcified LAD, total occlusion at middle segment, distal LAD from RCA

Coronary angiography

XB 3.5/6F, JR 3.5/5F, Fielder XT-A, Microcatheter fine cross

TCTAP 2015

Trapped wire

XB 3.5/6F, JR 3.5/5F, Fielder XT-A, Microcatheter fine cross

TCTAP 2015

How to treat??

TCTAP 2015

1st Ballon inflation

Ballon Tazuna 2.0/20 mm, inflate 14 atm and pulled all system

TCTAP 2015

evaluation

Wire floating from LAD-femoral artery

TCTAP 2015

evaluation

Wire floating from LAD-femoral artery

TCTAP 2015

2nd with Snare

Snare at femoral artery and Aorta Arc but failed

TCTAP 2015

3rd two wire

Double wire to catch the wire at femoral artery

TCTAP 2015

4th Three wire

JL 3.5/6F, 3 wire to catch the traped wire

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Succesful Catch the wire

Pull out all system and all wire

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LCx

LAD LM

TRAPPED WIRE

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LM LAD

LCx

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After retraction

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E

V

A

L

U

A

T

I

O

N

TCTAP 2015

Take Home Message

• Succesful CTO intervention depends on

selection of guiding catheter, backup catheter

and wire

• consider for CABG in very long lesion and

severe calcification

• Knowing wire and microcatheter

characteristics

• Right solution to treat complications that

might be happened on trapped wire

TCTAP 2015

Thank You