Crossing of a CTO lesion while tackling perforation


Andreas Synetos
Konstantinos Toutouzas


Δημοσίευση 08/09/2020

Περιγραφή: A 60 year gentleman underwent PCI of a CTO of the RCA. We used a 7F AL1 guide catheter through the right femoral artery, and a 6F JL3.5 through the right radial artery for contralateral injection. While trying to cross the lesion with a hydrophilic wire loaded to a microcatheter, contrast extravasation was noticed (type II perforation). The patient was hemodynamically stable without signs of overt extravasation. We thus tried to conservatively treat the perforation by prolonged infusion of a 3.0mm balloon (~5 min). During the inflation, the patient was asymptomatic and we tried again to cross the occlusion using a hydrophilic wire through the balloon catheter. Crossing was successful, while contrast extravasation was no longer present. We subsequently treated the lesion with two 3.0x30mm and 2.5x30mm DES, following predilation with 2.0mm and NC 3.0mm balloons.
After successful treatment of the CTO lesion, we treated the LAD lesion by implantation of a 2.50x28mm DES following 2.0mm balloon predilation through an XB 3.5 6F catheter.

Συμπέρασμα: While perforations are possible complications of CTO intervention, it is important to consider a stepwise approach for their treatment and reevaluate the need for additional steps or aborting the procedure. In this case our initial approach was successful in treating the complication, while the fact that the patient remained stable and asymptomatic enabled our simultaneous attempt for treatment of the CTO lesion.

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