Experts "Live" CTO Workshop 2014 25th Septemper 2014 in Madrid, Spain

1. when things might go
wrong, usually they do
(reverse murphy law
technique)
bernhard reimers
andrea pacchioni
Mirano

2. BRIEF INTRO: the patient
Male, 57 yrs old
Active smoker, Hypertension, Dyslipidemia
2012: NSTEMI
• 80% mid LAD PCI w DES
• 100% prox RCA unsuccesfull antegrade
LVEF 54%
optimal medical therapy (DAPT – β blocker – ACEI – statin -
nitrates)
2013: positive stress test @ mid level

3. July 2013: diagnostic coronary
angiography

6. strategy?
• Pump up medical therapy: add ivabradine/ranolazine
• RCA CTO: antegrade again
fix LM and then retrograde
Blunt stump
Big side
branch
Good septal collaterals

8. dye amount: 250 ml (iodixanol 320)
fluoroscopy time: 26’
radiation: 216090 milligray/cm2
in cath lab: 8 am to 10.15 am
introducers: 2 terumo destination 8 fr 45 cm
guiding cath: AL 1.5 SH asahi hyperion 8 Fr & Cordis XB 4 8 Fr
wires: asahi sion - sion blue - abbott bmw
microcath: Asahi corsair 150 cm
stent: abbott xience V 3.5 - 18 mm
balloons: quantum 3.5 - 15 mm
coils: 2 vortx 3 - 2.5 mm
ivus: Volcano

9. follow up
hs troponin peak 82 ng/l
hospital stay: 4 days
minimum pericardial effusion @ echo (completely
resolved before discharge)
telephone FU: fine, living in sardinia, asymptomatic
(ivabradine added)

10. what we learned
keep the entire screen (do not focus only on
coronaries)
look for complications (also where you do not
expect any)
have a panic box with inside: pericardiocenthesis
set - coils - fast echo - covered stent