Antegrade Approach to Stumpless Chronic Total Occlusion of Ostial Left Anterior Descending Artery: First Using a Side Branch Cutting Technique

作者：Dai, Jian; Katoh, Osamu; Kyo, Eisho^*; Tsuji, Takafumi; Watanabe, Satoshi; Ohya, Hidefumi

来源：Hellenic Journal of Cardiology, 2014, 55(1): 70-76.

• Chronic total occlusion
• percutaneous coronary intervention
• side branch
• intravascular ultrasound

The approach to a chronic total occlusion (CTO) still remains one of the most technical challenges in percutaneous coronary intervention (PCI). CTO lesions with a blunt entry point, calcification, and failure of a previous approach, are the independent predictors of CTO-PCI failure. Here we report a successful antegrade approach for reattempted CTO-PCI of a left anterior descending artery (LAD) with unknown, calcified ostium. We used a novel side branch cutting technique, combined with intravascular ultrasound-guided wiring and parallel wire techniques. Considering the ramus artery as a side branch and dilating it with a cutting balloon was a crucial part of the strategy for achieving overall procedural success using this approach. This is the first report describing a side branch cutting technique in CTO-PCI. The combined application of multiple antegrade techniques, using the latest devices, might provide an effective and safe approach for complex CTO-PCI.

• 出版日期2014-2
• 单位上海中医药大学