4th European Live Summit on Retrograde CTO Revascularization - May 8–9, 2015, in Zurich, Switzerland

1. CTO PCI retrograde case.
Stucked retrograde wire.
Dr. Artis Kalnins
Riga EAST University hospital
LATVIA

2. Case summary
• Male 82y.o.
• Clinical presentation : Exertional angina and
dyspnoe(CCSC 3)
• Past/clinical hystory:
CABG 1994,
MI 1993,2000,2011,
PCI with BMS and DES to venus grafts to RCA and to
LAD (2000, 2001,2011, 2012)
Repeatedly admited in hospital during last year with
chest pain and unstable angina despite OMT

3. CAG 2014 AUG
• LAD occl.
• LCX occl.
• RCA occl.
• LIMA graft occl.
• Last remaining
venus graft to LAD
patent, collaterals
to distal RCA

4. LAD, LCX occl.

5. RCA occl., venus graft to RCA occl.

6. Last remaining venus graft to RCA patent, collaterals to
distal RCA

7. Contralateral injections

8. Contralateral injections, antegrade approach

9. Retrograde approachAntegrade approach

12. Reverse CART attempt

13. Retrograde GAIA wire get stucked in the RCA middle
part calcium
• After tried to advance Corsair , the wire and Corsair was stuck
• Attempt pulling several times,the wire became unravel and elongated since tip of wire
was still unmoved while another end was freely pulled out.

14. Options?

17. 1,0-10mm balloon

18. Predilatation with 1.0-10 mm balloon at high pressure could
not free the stuck wire.

20. Corsair removement

21. Unsuccessfull attempts to advance balloon and Corsair
After manipulated to pull out, the guidewire became elongated

22. Unsuccessfull attempts to remove retrograde wire

23. After 5 hours fight procedure
was stopped and patient was
transfered to other hospital with
cardiac surgery.

24. Final angiogram

25. • Total procedure time 5h. 10min
• X ray time 124min
• Contrast 350ml

26. Next day was done CABG with venus graft to RPD.
Stucked coronary wire was cut and removed.

27. Open RPD
Wire
Diafragma
Old venus graft
to RCA
RV
with hematoma
RA
with canula

28. Removed wire

29. • Patient was discharged from hospital after 6
days without any complains.

30. Thank you for your attention!