June 20th, 2012

C3 Global Summit, June 20, 2012

The coronary track this morning began with discussions of the rationale for CTO interventions in “the era of appropriate use criteria” and of how to recognize unfavorable features for CTO PCI. The session concluded with two live case transmissions.

The first case was of a 55-year-old man, an exsmoker with a history of diabetes mellitus and hypertension, who presented with a proximal LAD CTO. The case was transmitted from Guangdong Provincial Hospital in Guangzhou, China. The patient had prior stenting of the LM and proximal Cx. He had been complaining of angina for 1 month. Stress imaging suggested anterior wall ischemia. The expert panel elected to attempt crossing the LAD from a retrograde fashion using a right-to-left collateral via the RCA.  This case also used IVUS, which was a great review of yesterday’s topic.

The second case was transmitted from Lilavati Hospital in Mumbai, India. The patient was a 75-year-old without diabetes or hypertension who had a previous history of inferior-wall MI. He presented with complaints of exertional dyspnea.  Echo showed LVEF of 55% with inferior septal and basal inferior-wall hypokinesis. Angiography revealed a 99% proximal calcific eccentric lesion, ostial LAD calcified lesion, followed by a mid-LAD bifurcation lesion. Because an IVUS catheter could not be passed through the RCA lesion, a rotational atherectomy device was used. After atherectomy, a 2.75-mm noncompliant balloon was used to post-dilate so that the IVUS catheter could pass. A 3.0-mm drug-eluting stent was selected for deployment in the lesion with post-dilation to 3.4 mm. Next the physicians used IVUS to evaluate the calcified lesions in the LAD. Rotational atherectomy was once again used to make the plaque more suitable for stent deployment in the bifurcation lesion. Unfortunately, the session ran out of time before the case was completed. Even so, the discussion was extremely helpful for us in attendance. So far, C3 has been a great learning experience for this Fellow. I will keep you posted!

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