Korean Circ J.  2019 Apr;49(4):366-368. 10.4070/kcj.2018.0435.

Unexpected Stenosis within Significantly Enlarged Distal Vessel after Successful Coronary Chronic Total Occlusion Recanalization

• Lee PH
• Lee SW
• Habara M
• Nasu K

• KMID: 2441142
• DOI: http://doi.org/10.4070/kcj.2018.0435

Abstract

No abstract available.

MeSH Terms

Constriction, Pathologic*

Figure

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  Figure 1 Baseline coronary angiography and procedure. (A) Diagnostic coronary angiography demonstrated CTO of the right coronary artery. (B) Because of the ambiguous proximal cap, a retrograde approach through a septal collateral was selected. (C) Direct wire crossing technique with an intermediate stiff Ultimate Bros 3 (Asahi Intecc, Aichi, Japan) guidewire was used to cross the CTO lesion. (D) Retrograde wire was externalized into the guiding catheter. CTO = chronic total occlusion.

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  Figure 2 Stent implantation and final result. (A) A distal landing zone was identified after predilation of the CTO lesion. (B, C) Two drug-eluting stents (Resolute Onyx, 4.0×22 and 3.5×38 mm) were implanted in the middle segment of the right coronary artery. (D) Final result with angiographic evidence of diffuse luminal narrowing of distal bed (Supplementary Video 1). CTO = chronic total occlusion.

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  Figure 3 Angiographic follow-up. (A) A 9-month angiographic follow-up showed a significant improvement in the diameter of the whole distal bed, with an unexpected severe “true” stenosis within the enlarged vessel. (B) A 3.5×30 mm Resolute Onyx stent was used to treat the lesion (Supplementary Videos 2 and 3).

Reference

1. Galassi AR, Tomasello SD, Crea F, et al. Transient impairment of vasomotion function after successful chronic total occlusion recanalization. J Am Coll Cardiol. 2012; 59:711–718.

2. Zivelonghi C, Suttorp MJ, Teeuwen K, et al. Clinical implications of distal vessel stenosis after successful coronary chronic total occlusion recanalization. JACC Cardiovasc Interv. 2018; 11:2343–2345.

3. Neishi Y, Okura H, Kume T, Fukuhara K, Yamada R, Yoshida K. Prediction of chronic vessel enlargement by a novel intravascular ultrasound finding. Circ J. 2015; 79:607–612.