i, made junior rina artha, do not have a financial

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

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evaluation

Wire floating from LAD-femoral artery

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evaluation

Wire floating from LAD-femoral artery

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2nd with Snare

Snare at femoral artery and Aorta Arc but failed

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3rd two wire

Double wire to catch the wire at femoral artery

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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