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Mark Rosenberg - Complication CaseEuroCTO Club Meeting 2016
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Transcript of Mark Rosenberg - Complication CaseEuroCTO Club Meeting 2016
![Page 1: Mark Rosenberg - Complication CaseEuroCTO Club Meeting 2016](https://reader033.fdocuments.net/reader033/viewer/2022051706/587ae23b1a28ab542b8b694f/html5/thumbnails/1.jpg)
Innere Medizin III, Campus Kiel
Schwerpunkt Kardiologie und Angiologie
Complication Case
EuroCTO Club Meeting 2016
11.1
0.2
016
Mark Rosenberg
University Medical Center Schleswig-Holstein
Campus Kiel, Germany
Dept. Cardiology, Angiology and Intensive Care Medicine
![Page 2: Mark Rosenberg - Complication CaseEuroCTO Club Meeting 2016](https://reader033.fdocuments.net/reader033/viewer/2022051706/587ae23b1a28ab542b8b694f/html5/thumbnails/2.jpg)
Innere Medizin III, Campus Kiel
Schwerpunkt Kardiologie und Angiologie
55 y/o gentleman
Stable Angina, CCS 3
Risk Factors: Hypertension, Dyslipidemia, Smoker
Non-invasive Tests:
Bicycle ergometer: ST-Segment depression II, III and aVF
Echocardiography: Normal left ventricular function
Coronary Angiography
Case Presentation
![Page 3: Mark Rosenberg - Complication CaseEuroCTO Club Meeting 2016](https://reader033.fdocuments.net/reader033/viewer/2022051706/587ae23b1a28ab542b8b694f/html5/thumbnails/3.jpg)
Innere Medizin III, Campus Kiel
Schwerpunkt Kardiologie und Angiologie
Coronary Angiography
LCARCA
![Page 4: Mark Rosenberg - Complication CaseEuroCTO Club Meeting 2016](https://reader033.fdocuments.net/reader033/viewer/2022051706/587ae23b1a28ab542b8b694f/html5/thumbnails/4.jpg)
Innere Medizin III, Campus Kiel
Schwerpunkt Kardiologie und Angiologie
• Coronary 2 Vessel Disease
– LAD stenosis in segment 7
– RCA occlusion in segment 2
• J-CTO Score 2 (blunt stump, occlusion length)
(Poor image quality)
• Interventional Plan
– Simultaneous contrast injection for clear visualization of the
CTO pathology
– Antegrade approach first with low threshold for switch to a
retrograde technique
Interpretation Coronary Angiography
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Innere Medizin III, Campus Kiel
Schwerpunkt Kardiologie und Angiologie
Coronary Angiography
Interventional setting:
Access: Bilateral femoral approach
Guiding Catheter: 90cm 7F AL 1.0 for RCA; 90 cm 7F EBU 4.0 for LCA
![Page 6: Mark Rosenberg - Complication CaseEuroCTO Club Meeting 2016](https://reader033.fdocuments.net/reader033/viewer/2022051706/587ae23b1a28ab542b8b694f/html5/thumbnails/6.jpg)
Innere Medizin III, Campus Kiel
Schwerpunkt Kardiologie und Angiologie
(1)Stop and referral to surgery
(2)Stop and retry in 6-8 weeks
(3)Try antegrade
(4)Try retrograde
(5)Stop and treat medically
What next ?????????
![Page 7: Mark Rosenberg - Complication CaseEuroCTO Club Meeting 2016](https://reader033.fdocuments.net/reader033/viewer/2022051706/587ae23b1a28ab542b8b694f/html5/thumbnails/7.jpg)
Innere Medizin III, Campus Kiel
Schwerpunkt Kardiologie und Angiologie
Interventional Collaterals
![Page 8: Mark Rosenberg - Complication CaseEuroCTO Club Meeting 2016](https://reader033.fdocuments.net/reader033/viewer/2022051706/587ae23b1a28ab542b8b694f/html5/thumbnails/8.jpg)
Innere Medizin III, Campus Kiel
Schwerpunkt Kardiologie und Angiologie
Successful Collateral Passage
![Page 9: Mark Rosenberg - Complication CaseEuroCTO Club Meeting 2016](https://reader033.fdocuments.net/reader033/viewer/2022051706/587ae23b1a28ab542b8b694f/html5/thumbnails/9.jpg)
Innere Medizin III, Campus Kiel
Schwerpunkt Kardiologie und Angiologie
Successful Recanalization RCA/RIVP
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Innere Medizin III, Campus Kiel
Schwerpunkt Kardiologie und Angiologie
(1)Stop and treat medically
(2)Stop and retry RPLA in 6-8 weeks
(3)Immediately try to reconstruct RPLA
What next ?????????
![Page 11: Mark Rosenberg - Complication CaseEuroCTO Club Meeting 2016](https://reader033.fdocuments.net/reader033/viewer/2022051706/587ae23b1a28ab542b8b694f/html5/thumbnails/11.jpg)
Innere Medizin III, Campus Kiel
Schwerpunkt Kardiologie und Angiologie
Successful Rewiring of the RPLA
![Page 12: Mark Rosenberg - Complication CaseEuroCTO Club Meeting 2016](https://reader033.fdocuments.net/reader033/viewer/2022051706/587ae23b1a28ab542b8b694f/html5/thumbnails/12.jpg)
Innere Medizin III, Campus Kiel
Schwerpunkt Kardiologie und Angiologie
Successful Reconstruction of the RPLA
![Page 13: Mark Rosenberg - Complication CaseEuroCTO Club Meeting 2016](https://reader033.fdocuments.net/reader033/viewer/2022051706/587ae23b1a28ab542b8b694f/html5/thumbnails/13.jpg)
Innere Medizin III, Campus Kiel
Schwerpunkt Kardiologie und Angiologie
Final Result
![Page 14: Mark Rosenberg - Complication CaseEuroCTO Club Meeting 2016](https://reader033.fdocuments.net/reader033/viewer/2022051706/587ae23b1a28ab542b8b694f/html5/thumbnails/14.jpg)
Innere Medizin III, Campus Kiel
Schwerpunkt Kardiologie und Angiologie
6 Months Follow Up
![Page 15: Mark Rosenberg - Complication CaseEuroCTO Club Meeting 2016](https://reader033.fdocuments.net/reader033/viewer/2022051706/587ae23b1a28ab542b8b694f/html5/thumbnails/15.jpg)
Innere Medizin III, Campus Kiel
Schwerpunkt Kardiologie und Angiologie
Always be careful with your guiding catheters
In case of a spiral dissection go retrograde
Avoid any contrast injection antegradely
Try to get the job done in one session
If necessary, it is also a good option to bring the patient back
to the cath lab after 6-8 weeks and retry the procedure
What have I learned from this case!
How will the vessel wall recover? Risk of negative
vessel remodelling with aneurysm formation?
How long should we keep the patient on DAPT?
![Page 16: Mark Rosenberg - Complication CaseEuroCTO Club Meeting 2016](https://reader033.fdocuments.net/reader033/viewer/2022051706/587ae23b1a28ab542b8b694f/html5/thumbnails/16.jpg)
Innere Medizin III, Campus Kiel
Schwerpunkt Kardiologie und Angiologie
Always be careful with your guiding catheters
In case of a spiral dissection go retrograde
Avoid any contrast injection antegradely
Try to get the job done in one session
If necessary, it is also a good option to bring the patient back
to the cath lab after 6-8 weeks and retry the procedure
What have I learned from this case!
How will the vessel wall recover? Risk of negative
vessel remodelling with aneurysm formation?
How long should we keep the patient on DAPT?