Kopyası hüseyinsürücü-vaka16.3.qxp

TGKD Cilt 16, Sayı 3
Ağustos 2012:115-116
Sürücü ve ark.
Chronic total occlusion
115
RETROGRADE RECANALIZATION OF A CHRONIC TOTAL
OCCLUSION OF RIGHT CORONARY ARTERY
Hüseyin Sürücü M.D1, Mehmet Meriç M.D2
Private Avcılar Anadolu Hospital, Cardiology Department, İstanbul, 2Avrupa Şafak Hospital,
Cardiology Deparment, İstanbul-Turkey
1
Miyokard enfarktüsü, hipertansiyon ve hiperlipidemili ve sigara alışkanlığı (20 sigara/gün/10
yıl) bulunan 64 yaşında bir erkek vakayı sunuyoruz.
Hastanın sağ koroner arter kronik total oklüzyonu, hem antegrad ve hemde retrograd wiring
sistem ile tedavi edildi. Bizim vakamızın
INTRODUCTION
Recently, chronic total occlusion (CTO) has come
into use all over the world and it has been standardized. The first step is an antegrade approach using
single wire. The second strategy would be parallel wire
technique. And the next technique would be a retrograde approach. In this method, retrograde wiring with
corsair is done at first. If it is successfully, externalization is established using 300 cm wire, and this system
is able to provide strong back-up support. If it fails, retrograde subintimal tracking (CART) technique is the
next step. IVUS guided wiring is a last resort. The
second wire is manipulated with IVUS guidance. Now,
initial success rate is more than 90 % with these
methods1.
We present the case of 64 year-old male patient
with history of myocardial infarction, hypertension,
hyperlipidemia, and previous smoking habit (20 cigarettes per day for 10 years). He complain post-myocardial angina pectoris and was treated aspirin, ramipril,
metoprolol and atorvastatin. His ECG was pictured in
Figure 1. Coronary angiography was performed in
Avrupa Şafak hospital. We show that proximal RCA
was CTO (Figure 2).
Although the antegrade approach is the most common method of CTO recanalization, a retrograde
attempt improves the success rate and its usage has
been increasingly adopted in the recent years2. So, we
Correspondence Address: Hüseyin SÜRÜCÜ MD
Bahçeşehir, 1. kısım mahallesi, Süzer
Bulvarı, Defne 2 ada, dışkapı No:10
Daire: 25 Başakşehir, İstanbul
E-mail: [email protected]
Geliş Tarihi:09.01.2012
Kabul Tarihi:03.04.2012
tedavisinde, kronik total oklüzyon için antegrad ve
retrograd uygulama en önemli seçenekti.
Anahtar kelimer: Kronik total oklüzyon, Retrograd rekanalizasyon
(Türk Girişimsel Kard. Der. 2012;16:115-116)
report a case of retrograde recanalization of proximal
right coronary artery (RCA) CTO via using circumflex
coronary artery collateral (Figure 3). Then, we don't
choice retrograde wire capture and externalization.
After CTO was recanalization, antegrad wiring was
performed at retrogradely access line (Figure 4).
Finally, we accomplished sufficiently antegrade wiring
while first antegrade attempt was not successfully. We
perform successful percutaneous coronary intervention
via using antegradely wiring system (Figure 5). As a
result, application of antegrade and retrograde way to
treat CTO constitutes the most important point in our
case management. Therefore, we propose our case
report to be unique and novel compared to classical
approaches published in literature1,2.
Figure 1: Patient's electrocardiography
116
Sürücü ve ark.
Chronic total occlusion
TGKD Cilt 16, Sayı 3
Ağustos 2012:115-116
Figure 2: Coronary angiography in right cranial position.
Figure 3: Retrograde recanalization of proximal right coronary artery.
Figure 4: Antegrad wiring was performed at retrogradely
access line.
Figure 5: Coronary angiography after successfully percutaneously coronary intervention.
REFERENCES
1. Asakura Y. Current strategy in PCI for CTO.
Nihon Rinsho. 2011;69:240-43.
2. Bufe A, Haltern G, Dinh W, Wolfertz J, Schleiting
H, Guelker H. Recanalisation of coronary
chronic total occlusions with new techniques
including the retrograde approach via collaterals.
Neth Heart J. 2011;19:162-67.