Korean Circ J.  2013 Apr;43(4):277-280. 10.4070/kcj.2013.43.4.277.

A Retrograde Approach to Coronary Ostial Stenosis after a Bentall Procedure in a Patient with Behcet's Disease

• Park TK
• Yang JH
• Yoo H
• Ahn J
• Jeon J
• Song YB
• Gwon HC

• KMID: 2224953
• DOI: http://doi.org/10.4070/kcj.2013.43.4.277

Abstract

We describe a case of chronic total occlusion of the right coronary artery ostium 5 months after a repeated Bentall procedure in a patient with Behcet's disease. In this patient, an antegrade approach to delivering the guidewire during percutaneous coronary intervention was not successful. Coronary angiography revealed the existence of collateral blood supply from the left coronary artery. Using a retrograde approach, a guidewire was successfully advanced from the distal left circumflex artery through the collateral vessel and into the posterolateral branch of the right coronary artery. After the guidewire crossed over the occluded right coronary artery ostium and was snared into the ascending aorta, antegrade access for balloon and stent delivery succeeded.

Keyword

Behcet disease; Percutaneous coronary intervention; Coronary occlusion

MeSH Terms

Aorta
Arteries
Behcet Syndrome
Constriction, Pathologic
Coronary Angiography
Coronary Occlusion
Coronary Vessels
Glycosaminoglycans
Humans
Percutaneous Coronary Intervention
SNARE Proteins
Stents
Glycosaminoglycans
SNARE Proteins

Figure

• 

  Fig. 1 Initial coronary angiography from the previous hospital. A: significant tubular stenosis at the left main coronary artery (white arrow). B: ostial occlusion with thrombolysis in myocardial infarction 1 flow at the right coronary artery (white arrow). C: final angiography after stent implantation of left main coronary artery at the previous hospital. Collateral flow supplied to proximal right coronary artery.

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  Fig. 2 Electrocardiography before (A) and after (B) revascularization.

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  Fig. 3 Revascularization for chronic total occlusion (CTO) in right coronary artery. A: patent stent at the left main coronary artery. Collateral flow supplied from the left coronary artery to the right coronary artery (white arrows). B: a Finecross™ microcatheter (Terumo, Tokyo, Japan) was further advanced into the CTO lesion (white arrow). C: a Runthrough™ NS (Terumo, Tokyo, Japan) was crossed over the CTO lesion. D: snaring of the retrograde guidewire into the ascending aorta (white arrow). E: a retrograde guidewire was pulled out of the sheath placed in the right femoral artery (white arrow). F: final angiogram with no residual stenosis.

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