Cath Lab Digest

A 70-year-old gentleman presented with moderate angina pectoris. He had undergone CABG over 10 years ago with an internal mammary to his LAD and a saphenous vein graft to his right coronary artery. A moderate-sized ramus vessel had undergone previous stenting first in 2000, then in 2001, with brachytherapy in February and May of 2001. His risk factors include diabetes mellitus and hyperlipidemia. He has in the past shown lateral ischemia and underwent a catheterization 3 months ago showing persistent occlusion of the ramus with stents present in the vessel. Eight years prior to this hospitalization, he had an attempted PCI with an experienced CTO operator that was unsuccessful. He continues to experience angina with moderate activity and was quite frustrated. His coronary arteriogram performed with a JF4 guiding catheter showed the persistent 100% CTO. The Miracle 3 wire (Abbott-Asahi, Abbott Park, Illinois) placed in a transit catheter (Cordis, Bridgewater, New Jersey) was able to be passed about 4 or 5 mm into the CTO. We exchanged for a FineCross (Abbott-Asahi), and subsequently a Corsair (Abbott-Asahi) catheter, which could almost cross the entire CTO; however, the distal portion of the CTO, 5–8 mm prior to the distal cap, could not be further crossed. We exchanged for a 1.5 Sprinter (Medtronic, Inc., Minneapolis, Minnesota) balloon, then predilated and placed a 2.75 x 28 mm Xience stent (Abbott-Asahi).

The interesting portion of this case is the that even though the procedure had been attempted 8 years ago, thanks to improvements in technology and technique, we were able to successfully navigate this CTO.

The patient is pain-free and happy that his vessel could be reopened. His previous stents were bare-metal. Hopefully, with the Xience stents, the long-term outcome will be better in terms of patency.

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Richard R. Heuser, MD, FACC, FACP, FESC, FSCAI, is an internationally-recognized cardiologist, inventor, educator and author. A diplomate of the American Board of Cardiovascular Diseases and American Board of Interventional Cardiovascular Diseases, Dr. Heuser is one of the early pioneers of angioplasty and is considered one of America’s top cardiologists. Dr. Heuser is currently in practice at the Phoenix Heart Center/Physicians Group of Arizona. He is Chief of Cardiology and Chief of Cardiac Catheterization Laboratory at St. Luke’s Hospital and Medical Center, Phoenix, Arizona, and Clinical Professor of Medicine at the University of Arizona College of Medicine, as well as Director of the Interventional Fellowship Program at the University of Arizona College of Medicine, Phoenix Campus.

With 13 patents granted for different catheters, stents and other medical devices, Dr. Heuser has served as principal investigator to research the safety and/or effectiveness of more than 100 medical devices and 70 pharmaceutical products, and has participated in more than 150 research studies. He has authored over 400 articles, textbooks and medical manuscripts, and is frequently invited to international medical conferences to present the findings of research developed in Phoenix.

Dr. Heuser received his medical degree from the University of Wisconsin School of Medicine in Madison, Wisconsin, and completed his medicine internship and residency, as well as his cardiology fellowship, at The Johns Hopkins Hospital in Baltimore, Maryland.