Long RCA Occlusion: Application of the Various Techniques for Successful Treatment

Please register or log-in to see the video.

About the Video:

This is a case of a 65-year-old man with prior coronary artery bypass graft surgery (17 years prior) who presented with exertional angina. A dobutamine stress echocardiography showed inferior ischemia. Diagnostic angiography demonstrated that there were occlusions of the proximal right coronary artery and the mid-left anterior descending artery. All bypass grafts were occluded except for a left internal mammary artery graft to the left anterior descending artery.

We decided to attempt intervention of the right coronary artery occlusion. Due to lesion complexity, a primary retrograde approach was used for lesion crossing. The first septal collateral branch was successfully crossed with a Sion guidewire over a FineCross microcatheter.

Retrograde engagement of the lesion initially failed, as did antegrade crossing attempts. The retrograde guidewire was exchanged for a Pilot 200 guidewire that formed a knuckle that crossed the lesion subintimally until the proximal right coronary artery.

Re-entry into the proximal true lumen was achieved using the reverse-CART technique, followed by wire-snaring and externalization. After stent implantation, TIMI-3 antegrade flow was restored in the right coronary artery, resulting in resolution of the patient’s exertional angina.

Request Information