Chronic Total Occlusion – Left Anterior Descending Proximal to Mid Lesion - Case study
Dr. Craig Rosen used the Teleport® Microcatheter and several Sapphire® II PRO and Sapphire® NC Plus PTCA Balloons to perform a proximal to mid left anterior descending coronary artery (LAD) revascularization of a chronic total occlusion using stents.
A 60-year-old Caucasian male patient with a BMI of 29, so overweight but not obese, presented with high cholesterol. Patient reported chest pain and had a positive stress test. An angiography of the LAD revealed a chronic total occlusion of the proximal to mid segment.
Angiography of the LAD revealed a chronic total occlusion of the proximal to mid segment. Right femoral artery access was achieved with a 6 Fr sheath and the left femoral artery access was achieved with a 6 Fr sheath for dual injections. The right was upsized to an 8 Fr 45 cm flexible sheath and the left was upsized to a 7 Fr 45 cm sheath.
After the use of multiple guidewires, the lesion was crossed, and a 135 cm Teleport Microcatheter 2.0 Fr was used to further access to the lesion in the proximal LAD. Teleport is often pulled as it offers the lowest profile, torqueable microcatheter. Teleport allows for added guidewire support and added guidewire tip penetration when accessing tight lesions. A 2.0 mm x 15 mm Sapphire II PRO PTCA Balloon was inflated first at 12 ATM in the proximal LAD and again at 10 ATM in the mid LAD.
Intravascular Ultrasound (IVUS) was performed of the proximal and mid LAD. A 4.0 mm x 18 mm stent was placed in the proximal LAD and inflated to 10 ATM. This was followed by a 2.75 mm x 23 stent at 14 ATM in the mid LAD which was initially inflated and then reinflated at 18 ATM for stent overlap. Post-dilation of the stents was achieved by a 4.0 mm x 18 mm Sapphire NC Plus PTCA balloon, which was inflated in the mid LAD then reinflated in the proximal LAD multiple times. The Sapphire NC Plus was chosen as the NC PTCA option for post-dilatation as it was designed to have excellent re-wrap and withstands multiple inflations. This was followed by a 4.5 mm x 8 mm Sapphire NC Plus PTCA balloon for further stent expansion in the proximal LAD.
After the treatment of the proximal and mid LAD, balloons were used to treat the first diagonal. A 3.25 mm x 15 mm Sapphire NC Plus PTCA balloon was inflated in the first diagonal of the LAD. Utilizing the Kissing Balloon Technique, a 2.5 mm x 12 mm Sapphire II PRO was inflated in the proximal LAD. This technique was used to optimize the ostium of the diagonal artery.
Finally, a 3.25 mm x 18 mm Sapphire NC Plus PTCA balloon was inflated in the mid LAD multiple times. Following the final balloon inflation, IVUS imaging was performed to confirm optimal stent apposition.
- The Teleport Microcatheter allowed for added guidewire support and guidewire tip penetration to access the CTO and successfully complete the procedure.
- The Sapphire II PRO PTCA balloon catheter was used to further dilate the lesion to allow for imaging.
- IVUS allowed for proper vessel measurement for optimal stent apposition.
- The Sapphire NC Plus PTCA balloon catheter successfully post-dilated the stents, utilizing Kissing Balloon Technique through a 7 Fr guide.
Case Study At a Glance
- Category : Coronary
- Access : Transfemoral
- Lesion Location : LAD, Diagonal
- CSI Device : Sapphire II Pro, Sapphire NC, Teleport Microcatheter
- Lesion / Anatomy : CTO Crossing
- Imaging :IVUS
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