Kopyası hüseyinsürücü-vaka16.3.qxp
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Kopyası hüseyinsürücü-vaka16.3.qxp
TGKD Cilt 16, Sayı 3 Ağustos 2012:115-116 Sürücü ve ark. Chronic total occlusion 115 RETROGRADE RECANALIZATION OF A CHRONIC TOTAL OCCLUSION OF RIGHT CORONARY ARTERY Hüseyin Sürücü M.D1, Mehmet Meriç M.D2 Private Avcılar Anadolu Hospital, Cardiology Department, İstanbul, 2Avrupa Şafak Hospital, Cardiology Deparment, İstanbul-Turkey 1 Miyokard enfarktüsü, hipertansiyon ve hiperlipidemili ve sigara alışkanlığı (20 sigara/gün/10 yıl) bulunan 64 yaşında bir erkek vakayı sunuyoruz. Hastanın sağ koroner arter kronik total oklüzyonu, hem antegrad ve hemde retrograd wiring sistem ile tedavi edildi. Bizim vakamızın INTRODUCTION Recently, chronic total occlusion (CTO) has come into use all over the world and it has been standardized. The first step is an antegrade approach using single wire. The second strategy would be parallel wire technique. And the next technique would be a retrograde approach. In this method, retrograde wiring with corsair is done at first. If it is successfully, externalization is established using 300 cm wire, and this system is able to provide strong back-up support. If it fails, retrograde subintimal tracking (CART) technique is the next step. IVUS guided wiring is a last resort. The second wire is manipulated with IVUS guidance. Now, initial success rate is more than 90 % with these methods1. We present the case of 64 year-old male patient with history of myocardial infarction, hypertension, hyperlipidemia, and previous smoking habit (20 cigarettes per day for 10 years). He complain post-myocardial angina pectoris and was treated aspirin, ramipril, metoprolol and atorvastatin. His ECG was pictured in Figure 1. Coronary angiography was performed in Avrupa Şafak hospital. We show that proximal RCA was CTO (Figure 2). Although the antegrade approach is the most common method of CTO recanalization, a retrograde attempt improves the success rate and its usage has been increasingly adopted in the recent years2. So, we Correspondence Address: Hüseyin SÜRÜCÜ MD Bahçeşehir, 1. kısım mahallesi, Süzer Bulvarı, Defne 2 ada, dışkapı No:10 Daire: 25 Başakşehir, İstanbul E-mail: huseyinsurucu@hotmail.com Geliş Tarihi:09.01.2012 Kabul Tarihi:03.04.2012 tedavisinde, kronik total oklüzyon için antegrad ve retrograd uygulama en önemli seçenekti. Anahtar kelimer: Kronik total oklüzyon, Retrograd rekanalizasyon (Türk Girişimsel Kard. Der. 2012;16:115-116) report a case of retrograde recanalization of proximal right coronary artery (RCA) CTO via using circumflex coronary artery collateral (Figure 3). Then, we don't choice retrograde wire capture and externalization. After CTO was recanalization, antegrad wiring was performed at retrogradely access line (Figure 4). Finally, we accomplished sufficiently antegrade wiring while first antegrade attempt was not successfully. We perform successful percutaneous coronary intervention via using antegradely wiring system (Figure 5). As a result, application of antegrade and retrograde way to treat CTO constitutes the most important point in our case management. Therefore, we propose our case report to be unique and novel compared to classical approaches published in literature1,2. Figure 1: Patient's electrocardiography 116 Sürücü ve ark. Chronic total occlusion TGKD Cilt 16, Sayı 3 Ağustos 2012:115-116 Figure 2: Coronary angiography in right cranial position. Figure 3: Retrograde recanalization of proximal right coronary artery. Figure 4: Antegrad wiring was performed at retrogradely access line. Figure 5: Coronary angiography after successfully percutaneously coronary intervention. REFERENCES 1. Asakura Y. Current strategy in PCI for CTO. Nihon Rinsho. 2011;69:240-43. 2. Bufe A, Haltern G, Dinh W, Wolfertz J, Schleiting H, Guelker H. Recanalisation of coronary chronic total occlusions with new techniques including the retrograde approach via collaterals. Neth Heart J. 2011;19:162-67.