Complex coronary cases
PCI of CTO of Anomalous RCA Originating from Left Coronary Sinus – March 2014

76 year-old-woman with new onset CCS Class III angina, exertional dyspnea and positive ETT presented on March 3, 2014. A cardiac cath revealed native 3 vessel coronary artery disease (RCA, LAD, LCx; SYNTAX score of 17) and normal LV function. Patient had successful intervention of mid LAD and distal LCx using Promus Premier drug eluting stents. Now planned for PCI of chronic total occlusion of anomalous RCA originating from left coronary sinus.
Moderator: Sameer Mehta, MD

1:44:14

Q&A
Q
For an anomalous RCA, what would be your first choice of catheter?
A.

AL1 will be first choice but lot will depend on the exact RCA orifice origin.


Q
Please mention the catheters of choice for the anomalous RCA in positions A-D.
A.

Position A (above LCA ostium)- FL3, Position B (below LCA ostium)- FCL3.5, Position C (just Rt of midline)- VL 3.5, Position D (around the midline)- AL1 (this is most common anomaly).


Q
In which situations with anomalous coronary arteries, will you unequivocally send a patient for surgery?
A.

Only if SCD survivor or significant ischemia on stress MPI and RCA cannot be engaged for PCI.


Q
What is your favored support catheter presently?
A.

Guideliner by far.


Q
Do you have a particular strategy for selecting support catheter or the Guideliner?
A.

Guideliner as work horse device and some un-crossable cases Corsair.


Q
Always 6 F for a Guideliner?
A.

Yes in majority (>90%) 6Fr Guideliner and 7Fr in remaining 10%.


Q
What is your distribution of use among the newer DES available in your cath lab?
A.

Approximate DES distribution in our lab is as follows; 60% Xience Xpedition, 35% Promus Premier and 5% Resolute Integrity.


Q
Any situations where you would still use a BMS?
A.

Yes >5mm vessel (rare RCA or SVG) or in AMI setting where large residual thrombus burden or not sure of pts DAPT compliance. Rare case of semi-urgent non-cardiac surgery to be done in 1-2 mts, pt will also get BMS.


Q
Which DES do you prefer in the longest length?
A.

In my opinion all newer DES are comparable with similar efficacy and ST rates; we prefer 38mm long Xience Xpedition.


Q
And for the shortest diameter?
A.

Small Xience Xpedition leads the pack in our lab.


comments

Leave a Reply

Your email address will not be published. Required fields are marked *


By submitting this form, you are consenting to receive marketing emails from: Mount Sinai Hospital, One Gustave L. Levy Place, Box, New York, NY, 10029, https://ccclivecases.org. You can revoke your consent to receive emails at any time by using the SafeUnsubscribe® link, found at the bottom of every email. Emails are serviced by Constant Contact

suggestion
Suggestions
IVUS Guided PCI of LAD-D1 Bifurcation using Rotational Atherectomy and 2-Stent Mini-crush Technique – March 2021
Views 365

Case & Plan: 47-year-old female with ESRD on HD, presented with CCS Class I angina and a markedly positive SPECT MPI for anterior and lateral wall ischemia. A Cardiac Cath on February 23, 2021 revealed severely calcified 1 V CAD: 90% proximal LAD and diagonal bifurcation (Medina 1,1,1), 80% mid LAD and SYNTAX Score of […]


Complex prox RCA CTO Recanalization via Retrograde Approach – February 2021
Views 412

56-year-old male presented with Class III unstable angina and positive stress MPI for significant inferior ischemia. A Cardiac Cath on November 20, 2020 at outside hospital revealed 2 V VAD: 85% mid LAD, 70% D1 and CTO proximal RCA with distal vessel fills retrogradely via septal collaterals (J-CTO Score 3), LVEF = 50% and Syntax […]


High-Risk Complex PCI of Diffuse Multivessel CAD – January 2021
Views 673

  Case and Plan: 45-year-old male with multiple CAD risk factors presented to OSH on November 6, 2020 with unstable angina and positive ETT. A Cardiac Cath on November 9, 2020 revealed extensive 3V CAD: 100% mid LAD, 90% D2, 70% proximal LCx, 100% LCx-OM1, 100% mid RCA with LVEF = 60% and SYNTAX Score […]


Extremely Tortuous Angulated mid LAD Diagonal Bifurcation Lesion – December 2020
Views 817

Case and Plan: 75-year-old female presented with new onset CCS Class II angina and positive stress MPI on November 9, 2020 revealing moderate apical and inferior ischemia. A Cardiac Cath on November 24, 2020 revealed 2 V CAD: 95% proximal RCA, angulated tortuous 95% mid LAD bifurcation lesion, LVEF = 60% and SYNTAX Score = […]