OCT-Corner: Clinical case illustrating the importance  of IVUS imaging when deciding for optimal  PCI treatment in CTO patients

Prunea D; Kanoun Schnur SS; Stark C; Zirlik A; Toth GG; Harb S

Prunea D et al.

OCT-Corner: Clinical case illustrating the importance of IVUS imaging when deciding for optimal PCI treatment in CTO patients

Journal für Kardiologie - Austrian Journal of Cardiology 2023; 30 (7-8): 187-191

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Vollbildansicht	Angiographie Abbildung 1: Angiographic view of the ostial RCA CTO. Guiding catheter placed between aorta wall and old stent struts, PCI materials being delivered through the old stent struts. Gladius knuckle distal in extraplaque space causing subintimal hematoma. Keywords: Angiographie, Kardiologie


Vollbildansicht	CTO Abbildung 2: Across CTO ST™ (with front marker) finally passed the struts without being ruptured when inflated. Keywords: CTO, Kardiologie


Vollbildansicht	Angiographie Abbildung 3: Angiographic view after obtaining antegrade flow in the RCA (after predilatation with an escalation of Across CTO™ balloons, followed by Non-compliant (NC) and Scoring balloons). A. Angiographically underestimated proximal stenosis (double stent layer in calcified plaque). B. Calcified nodule (proven by IVUS) in the distal RCA. C. Stenosis at the Crux (on IVUS fibrotic). Keywords: Angiographie, Kardiologie


Vollbildansicht	IVUS Abbildung 4: IVUS Keywords: IVUS, Kardiologie


Vollbildansicht	IVUS Abbildung 5: IVUS Keywords: IVUS, Kardiologie


Vollbildansicht	IVUS Abbildung 6: IVUS Keywords: IVUS, Kardiologie


Vollbildansicht	RCA - DES Abbildung 7: Distal RCA DES implantation (calcified nodule) Keywords: DES, Kardiologie, RCA


Vollbildansicht	IVUS Abbildung 8: IVUS Keywords: IVUS, Kardiologie


Vollbildansicht	IVUS Abbildung 9: IVUS Keywords: IVUS, Kardiologie


Vollbildansicht	RCA - ISR Abbildung 10: Proximal RCA ISR with recoil resisting aggressive balloon dilatations. Keywords: ISR, Kardiologie, RCA


Vollbildansicht	RCA - ISR Abbildung 11: Proximal RCA ISR treated with DES (due to persistent recoil, plain balloon angioplasty was considered insufficient). Keywords: ISR, Kardiologie, RCA


Vollbildansicht	Angiographie Abbildung 12: Final angiographic result Keywords: Angiographie, Kardiologie


Vollbildansicht	Schema Abbildung 13: In order to obtain better support, left distal radial access was preferred, and the guiding catheter was placed between the aortic wall and old stent struts which were protruding into the aorta. © Dan Prune Keywords: Kardiologie, Schema


Vollbildansicht	Side-Struts Abbildung 14: Partially dilated overlapping side-struts. Keywords: Kardiologie, Side-Struts


Vollbildansicht	Angiographie Abbildung 15: Angiographic view of the ostial RCA CTO. Guiding catheter placed between aorta wall and old stent struts, PCI materials being delivered through the old stent struts. Keywords: Angiographie, Kardiologie


Vollbildansicht	IVUS Abbildung 16: IVUS Keywords: IVUS, Kardiologie


Vollbildansicht	IVUS Abbildung 17: IVUS Keywords: IVUS, Kardiologie