The feasibility of transradial laser atherectomy for chronic total occlusion using the 5 Fr sheath system
Khaled Sherif1, Yasir Yaqub2, Jose A Suarez2
1Internal Medicine Department-Texas Tech University Health Sciences Center, Lubbock, TX, USA. k_a_sherif@hotmail.com.
Insights
This case report details the first use of laser atherectomy via a 5 French sheath for coronary artery chronic total occlusion (CTO). This radial approach demonstrated feasibility and improved blood flow in a patient with inferior wall ischemia.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary artery chronic total occlusion (CTO) poses a significant challenge in interventional cardiology.
- Traditional treatment options for CTO may have limitations, necessitating novel approaches.
- Minimally invasive techniques are increasingly explored for complex coronary interventions.
Observation:
- A 57-year-old male presented with retrosternal chest pain and evidence of inferior wall ischemia on myocardial perfusion scintigraphy.
- Coronary angiography revealed a chronic total occlusion (CTO) in the right coronary artery (RCA).
- A 5-French vascular sheath was successfully placed via the radial artery approach.
Findings:
- Laser atherectomy was performed across the RCA CTO using a 5-French sheath system.
- The intervention successfully re-established antegrade flow through the occluded segment.
- Immediate improvement in coronary blood flow was observed post-procedure.
Implications:
- This case highlights the feasibility of laser atherectomy with a 5-French sheath for managing coronary artery CTO.
- The radial artery approach offers a minimally invasive option for complex coronary interventions.
- Further research may explore the broader application and long-term outcomes of this technique in CTO treatment.
Objective:
We present a case of chronic total occlusion (CTO) approached with LASER endovascular intervention by radial artery approach using a 5 French sheath.
Case Report:
A 57-year-old man presented to our hospital having had retrosternal chest pain for two days. Physical examination was normal at the time of presentation. The laboratory tests were within normal limits, including cardiac enzymes except the lipid panel which showed hypertriglyceridemia. The patient underwent a myocardial perfusion scintigraphy stress test that revealed inferior wall ischemia, with normal left ventricular ejection fraction. A 5-French vascular sheath was placed in the right radial artery. Selective coronary artery angiography was performed, which showed right coronary artery (RCA) CTO. A 5-French JR4 guide catheter successfully engaged the RCA and Laser angioplasty was performed across the CTO into the RCA. A marked improvement of flow was evident thereafter.
Conclusion:
To best of our knowledge this is the first case report showing the feasibility of laser atherectomy using the 5 French sheath system in a coronary arterial CTO.
