Korean Circ J.  2011 Dec;41(12):747-749. 10.4070/kcj.2011.41.12.747.

Periprocedural Myocardial Infarction After Retrograde Approach for Chronic Total Occlusion of Coronary Artery: Demonstrated by Cardiac Magnetic Resonance Imaging

• Kim SM
• Gwon HC
• Lee HJ
• Choi JH
• Choi SH
• Yang JH
• Lee SY
• Song YB
• Hahn JY
• Choi JH
• Choi SH
• Lee SH

• KMID: 1776251
• DOI: http://doi.org/10.4070/kcj.2011.41.12.747

Abstract

A retrograde approach through the collateral channels was recently proposed as one of the most promising current techniques for percutaneous coronary intervention of chronic total occlusion in coronary arteries (CTO). This report describes the case of a 68-year-old man in whom CTO was successfully crossed with a wire by the retrograde approach using septal collateral, but the patient suffered from a complication with septal myocardial infarction demonstrated by cardiac magnetic resonance imaging.

Keyword

Coronary occlusion; Percutaneous transluminal coronary angioplasty; Complications; Myocardial infarction

MeSH Terms

Aged
Angioplasty, Balloon, Coronary
Coronary Occlusion
Coronary Vessels
Humans
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Magnetics
Magnets
Myocardial Infarction
Percutaneous Coronary Intervention

Figure

• 

  Fig. 1 Baseline left coronary angiography showed CTO lesion in the ostium of LAD (A). Right coronary angiography showed septal collateral from the RCA to LAD (B and C). Selective angiography using a microcatheter showed septal collateral (D). The guidewire was successfuly replaced from the RCA to LAD (E). Final coronary angiography showed successful result (F). LAD: left anterior descending artery, CTO: chronic total occlusion, RCA: right coronary artery.

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  Fig. 2 Pre-procedural cardiac MRI showed no evidence of delayed enhancement (A). Post-procedural cardiac MRI showed new delayed enhuncement in the septal area (B). A: Pre-PCI: normal MRI. B: Post-PCI: microinfarction as indicated by circles. PCI: percutaneous coronary interrention.

Reference

1. Safian RD, McCabe CH, Sipperly ME, McKay RG, Baim DS. Initial success and long-term follow-up of percutaneous transluminal coronary angioplasty in chronic total occlusions versus conventional stenoses. Am J Cardiol. 1988. 61:23G–28G.

2. Hamm CW, Kupper W, Kuck KH, Hofmann D, Bleifeld W. Recanalization of chronic, totally occluded coronary arteries by new angioplasty systems. Am J Cardiol. 1990. 66:1459–1463.

3. Surmely JF, Tsuchikane E, Katoh O, et al. New concept for CTO recanalization using controlled antegrade and retrograde subintimal tracking: the CART technique. J Invasive Cardiol. 2006. 18:334–338.

4. Chung SH, Kim MH, Yu LH, et al. Initial experience of retrograde wire approach in coronary chronic total occlusion intervention. Korean Circ J. 2009. 39:228–235. doi: 10.4070/kcj.2009.39.6.228.

5. Surmely JF, Katoh O, Tsuchikane E, Nasu K, Suzuki T. Coronary septal collaterals as an access for the retrograde approach in the percutaneous treatment of coronary chronic total occlusions. Catheter Cardiovasc Interv. 2007. 69:826–832.

6. Werner GS, Ferrari M, Heinke S, et al. Angiographic assessment of collateral connections in comparison with invasively determined collateral function in chronic coronary occlusions. Circulation. 2003. 107:1972–1977.

7. Saito S. Different strategies of retrograde approach in coronary angioplasty for chronic total occlusion. Catheter Cardiovasc Interv. 2008. 71:8–19.