1. Home
  2. Guidewire Cases
  3. Case 25: Angulated LAD Intervention Using Angulated Catheter

Case 25: Angulated LAD Intervention Using Angulated Catheter

Case Presentation

  • A 65-year-old man presented with a new onset CCS class II angina. CTA coronary showed high calcium score of 2684 with 2 V CAD (RCA and LAD).
  • PMH: Non insulin dependent DM, Hyperlipidemia
  • Medications: Aspirin, Rosuvastatin, Metoprolol, Metformin
  • Angiogram showed severely calcified 2 V CAD: 90% mid RCA, and multiple calcified severely angulated proximal and mid LAD/Diagonal bifurcation lesions.
  • Patient underwent successful PCI of RCA and here for staged PCI of LAD with the use of angulated catheter.

Case Description

Pre-Angiogram

PCI Strategy

  • 6F guide catheter
  • Runthrough wire with an angulated catheter to navigate the angulated LAD lesion
  • Lesion modification with cutting balloon angioplasty, followed by stent placement
  • Provision stenting technique

PCI Strategy

STEPS

  • First, navigate Runthrough wire into the diagonal branch.
  • Followed by Venture catheter advancement up to the LAD-Diagonal bifurcation.
  • Then, pull the wire back while maintaining the tip of Venture at the level of bifurcation.
  • Perform clockwise rotation of Venture to create 90-degree bend, followed by navigating Runthrough wire into the angulated LAD lesion.

STEPS

  • Then, the lesion modification was performed by using 3.5/6 mm Wolverine balloon.
  • Two DES were placed in proximal LAD (Promus 4/28 mm) and mid LAD (Promus 3/38 mm) with an excellent result.

Final Angiogram

Learning Points

  • Case planning is paramount in the angulated lesion intervention.
  • Wiring technique in angulated lesions is complex and often require adjunct device to negotiate the lesions.
  • Angulated catheters such as SuperCross, Venture, and Swift Ninja could help the guidewire to advance through the lesions in challenging and complex coronary artery disease interventions.

ModelBurst (ATM)Diameter (mm)Balloon Length (mm)
681215202530
MINI TREK (CTO INDICATED)1.271.2✓✓✓✓✓
1.561.5✓✓✓✓✓
2.172✓✓✓✓✓✓*✓*
TREK2.372.25✓✓✓✓✓✓✓
2.672.5✓✓✓✓✓✓✓
2.912.75✓✓✓✓✓✓✓
3.113✓✓✓✓✓✓✓
3.53.25✓✓✓✓✓✓✓
3.73.5✓✓✓✓✓✓✓
3.943.75✓✓✓✓✓✓✓
4.324✓✓✓✓✓✓✓
4.864.5✓✓
5.365✓✓
*Only available as RX, not as OTW. Other sizes available in both versions.
Retrieved on April 07 2022 from Abbott product ordering information. Please look at the company's files for the latest available data on device configurations and avilability in your area.

Left Main DK Crush Video ID