Chonnam Med J.  2014 Dec;50(3):112-114. 10.4068/cmj.2014.50.3.112.

Thrombotic Occlusion during Intravascular Ultrasonography-Guided Percutaneous Coronary Intervention of Stumpless Chronic Total Occlusion

• Lee UJ
• Kim HS
• Lee C
• Kim KY
• Kim W

• KMID: 2172155
• DOI: http://doi.org/10.4068/cmj.2014.50.3.112

Abstract

Percutaneous coronary intervention (PCI) of stumpless chronic total occlusion (CTO) lesions with a side branch stemming from the occlusion have a significantly lower treatment success rate because physicians cannot identify an accurate entry point with only conventional angiographic images. An intravascular ultrasonography (IVUS)-guided wiring technique might be useful for the penetration of stumpless CTO. We recently experienced thrombotic occlusion during an IVUS-guided stumpless CTO procedure. The cause of the thrombosis is not completely understood; the thrombosis may have been associated with the long use of the IVUS catheter. Special precautions should be taken to prevent thrombus in such cases.

Keyword

Thrombosis; Percutaneous coronary intervention; Ultrasonography, Interventional

MeSH Terms

Catheters
Percutaneous Coronary Intervention*
Thrombosis
Ultrasonography, Interventional

Figure

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  FIG. 1 Coronary angiographic findings during the PCI. (A) The intact left anterior descending artery (LAD) is shown 2 years previously by the white arrowhead in spider view. (B) At admission, the LAD is in a stumpless chronic total occlusion state with a side branch arising from the LAD ostium. (C) Diffuse thrombosis at the ramus intermedius 30 minutes after the IVUS-guided procedure. The thrombotic lesion is indicated by black arrows. (D) The final angiogram after thrombus aspiration and intracoronary abciximab bolus injection.

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  FIG. 2 Large red thrombus from the aspiration catheter.

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