Septal Collaterals in a Chronic Total Occlusion
Panagiotis Varelas1, Konstantinos Manousopoulos1, Konstantinos Filippou1
1Cardiology Department, Hellenic Red Cross Hospital Korgialenio-Benakio, Athens, Greece.
Insights
This case study demonstrates a successful retrograde percutaneous coronary intervention (PCI) for a chronic total occlusion (CTO) in the left anterior descending artery. The technique utilized ipsilateral septal collaterals for CTO revascularization in a patient with angina.
Area of Science:
- Interventional Cardiology
- Cardiovascular Disease
- Medical Case Reports
Background:
- Percutaneous coronary intervention (PCI) is a consideration for patients experiencing angina or ischemia.
- Chronic total occlusions (CTOs) present unique challenges in revascularization.
- This report details a specific CTO case requiring advanced interventional techniques.
Objective:
Percutaneous coronary intervention of a chronic total occlusion (CTO) should be considered in patients with angina or with documented ischemia. We present a patient with angina and stress echocardiography positive for ischemia in the anterior wall.
Key Steps:
The coronary angiography revealed a CTO in the left anterior descending artery, and a percutaneous approach was decided. The antegrade dissection reentry was unsuccessful. Retrogradely, through the ipsilateral septal collaterals, a SUOH wire was successfully advanced distally to the CTO. Externalization of the RG3 was successful, and the antegrade microcatheter was advanced inside the distal septal. Successful percutaneous coronary intervention of the left anterior descending artery was performed.
Potential Pitfalls:
Ping pong technique was not used, making the procedure challenging for equipment delivery.
Take-Home Messages:
One injection, one solution technique can be applied in selected cases with ipsilateral septal collaterals. Careful evaluation of the coronary anatomy before the procedure is mandatory.
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