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Use of sodium nitroprusside in retrograde percutaneous coronary intervention for chronic total occlusion: A case
He Huang1, Yao-Jun Zhang, Yong-Zhen Fan
1Department of Cardiology, Xiangtan Central Hospital, Xiangtan Department of Cardiology, Xuzhou Third People's Hospital Barts Health NHS Trust Department of Cardiovascular Sciences, University College London, London, UK.
Insights
Sodium nitroprusside improved collateral flow, enabling successful retrograde percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). This technique successfully crossed even invisible septal collateral connections.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
Background:
- Chronic total occlusion (CTO) presents significant challenges in percutaneous coronary intervention (PCI).
- Successful PCI in CTO lesions often relies on effective collateral channel utilization.
Rationale:
Chronic total occlusion continues to be a challenging lesion subset for percutaneous coronary intervention.
Patient Concerns:
A 65-year-old male patient was admitted with symptoms of angina pectoris for 9 months.
Diagnoses:
Coronary angiography showed a severe stenosis in the proximal left anterior descending artery and a chronic total occlusion (CTO) in the proximal right coronary artery. The complexity of the CTO was stratified using the J-CTO score and the PROGRESS CTO score.
Interventions:
Antegrade wire escalation for CTO of RCA failed. The septal collaterals to RCA were initially judged to be poor and not suitable for intervention.
Outcomes:
However, administration of sodium nitroprusside improved collateral flow and enabled the identification of retrograde channels suitable for wire crossing and successful retrograde PCI.
Lessions:
The study showed that faintly visible to even invisible septal collateral connections can be crossed with the septal "trial and error" surfing technique after the administration of sodium nitroprusside.
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