Case Review, Patient Management, Protected PCI

Complex Chronic Total Occlusion (CTO) Case  


John Troy Owens, DO, of Virginia Commonwealth University (VCU) Medical Center presents a case of a 62-year-old male with history of extensive coronary artery disease and prior CABG (LIMA-LAD, SVG-OM, SVG-PDA), severely reduced left ventricular function with history of apical aneurysm and resolved LV thrombus. Additionally, the patient had a history of ventricular tachycardia for which a prior ICD was placed. The patient was lost to follow-up and presented with dyspnea after walking a short distance of 100-200 feet. An angiogram at presentation showed that his SV-OM graft was occluded and SVG-PDA was patent but severely diseased. Therefore, the patient was referred to VCU for RCA chronic total occlusion (CTO) PCI.

During the procedure, the patient developed ischemia and hypotension so the team implanted the Impella® heart pump for hemodynamic support. With Impella support, the team was able to wire the CTO with the placement of a long stent in the mid-RCA. After the procedure, the Impella was explanted after one night in the CCU and the patient was discharged two days after.




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