Application of Reverse Wire Technique in An Ostial Left Main Total
Occlusion with Acute Coronary Syndrome
Yeh-Peng Chen, Ping-Han Lo, Jui-Sung Hung
China Medical University Hospital Taichung Taiwan
Case Summary
A 68-year-old male without specific CAD risk factors but medical
history of tongue SCC (T3N1M0) and syphylis without treatment was sent to our ER due to chest pain with dyspnea and hypotension in shock status. ECG showed LBBB and echocardiography revealed
LVEF of 18% with diffuse hypokinesis. Emergent cardiac catheterization was activated and CAG showed ostial LM total occlusion, there was no significant lesion over RCA with collaterals to RCA. For CABG was
declined, PCI was performed.
CAG
LM:
Ostial total occlusion
LAD:
Total occlusion
LCX:
Total occlusion
RCA:
No significant lesion
Collaterals:
From RCA to LCA
Interventional Management
Procedure Step:
IABP was inserted via right femoral artery first.
A 6Fr EBU3.5 guiding catheter was engaged into the left coronary artery through right radial approach. A 0.014-inch Fielder FC wire was crossed the lesion with a Corsair catheter assistance and placed into LAD. The lesions were then dilated with a Sprinter 2.5 X 20 mm balloon. Due to big angulation of ostial LCX, reverse wire technique was done with a Crusade catheter, and the lesion of LCX was crossed by another 0.014-inch
Fielder FC wire, then dilated with the same Sprinter 2.5 X 20 mm balloon. After IVUS study, we deployed a 3.0 X 18 mm Resolute integrity stent at LM to proximal LCX. We inserted an additional 0.014-inch Fielder FC wire to LAD and deployed a 3.0 X 22 mm Resolute integrity stent
successfully from ostial LM to proximal LAD with Culotte technique. Kissing ballooning was performed by using a 3.0 X 12mm NC Sprinter balloon at LM to proximal LAD and a 3.0 X 12 mm NC Sprinter balloon at LM to LCX. POT at proximal LM was done with a NC Sprinter 3.5 X 12 mm balloon finally. At the end of the procedure, IVUS study was checked that both stents were well expanded and apposited. Final angiogram showed that the procedure was successful.
