Proximal LAD CTO Retrograde Angioplasty With Double 6F Radial Approach: Interest Of CT Scan to Solve An Unusual Anatomy

Title PROXIMAL LAD CTO RETROGRADE ANGIOPLASTY WITH DOUBLE 6F RADIAL APPROACH : INTEREST OF CT SCAN TO SOLVE AN UNUSUAL ANATOMY Introduction The case shows that the use of a double 6F radial approach is safe and effective in CTO angioplasty It shows that the CT scan is very interresting in a complex CTO angioplasty Clinical Case A 50 years old female has CCS 3 angina The coronary angiogram shows a proximal LAD CTO. There is no other coronary lesion. The first angioplasty uses a double 6F radial approach. It was impossible to recanalyze the CTO with an antegrade technique A retrograde septal access was used The attempt failed because of a wrong way of the guidewire We did a coronary CT scan which showed that the first septal branch arises from the first diagonal branch et that the right way of the CTO was before the first septal branch The second attempt was successfull with : - double 6F radial approach - retrograde septal crossing with a Sion guidewire and a Corsair microcatheter - crossing of the CTO with a Gaia second guidewire - externalization of a RG3 guide wire - rendez vous microcatheters technique - stenting with an everolimus DES At 9 months the patient had unstable angina The coronary angiogram showed a restenosis before the DES in the ostial LAD We performed an angioplasty of the restenosis with a sirolimus DES with success At one year the patient is asymptomatic Discussion This cases shows the interest of the coronary CT scan to solve an usual coronary anatomy The question is : do we always have to do a coronary CT scan before the angioplasty of a complex CTO ?