A Useful Addition to Your Complex PCI Toolbox

TAKERU PTCA Balloon Dilatation Catheters (Terumo Interventional Systems) have proven to be a useful tool in complex coronary interventions. Due to its low profile and pushability, the TAKERU balloon catheter can be used in multiple scenarios, including tortuous  and uncrossable lesions. In this report, we summarize a case utilizing the low-profile TAKERU balloon catheter.

Clinical Case

A 65-year-old gentleman with a history of coronary artery disease treated with coronary artery bypass graft surgery and percutaneous coronary intervention (PCI) to the proximal left anterior descending artery presented with Canadian Cardiovascular Society class III angina despite multiple antianginals (carvedilol 12.5 mg BID, ranolazine 1000 mg BID, and isosorbide mononitrate 60 mg daily).

Other comorbidities included hypertension, hyperlipidemia, and diabetes, which were all appropriately treated. A cardiac positron emission tomography scan revealed a moderate-sized inferior wall reversible defect and normal left ventricular function. Coronary angiography revealed an occluded vein graft to the right coronary artery (RCA), as well as an occlusion of the RCA. Given the patient’s significant symptoms and ischemia, we proceeded with RCA PCI.

Procedure

Dual access was achieved with a 7 French Amplatz Left (AL)-1 guide catheter and a 7 French Extra Backup (EBU) 3.75 guide catheter. Based on dual-injection angiography, the proximal cap was ambiguous due to a tortuous right ventricular (RV) marginal branch and the occlusion was long (>20 mm) (Figure 1). Therefore, we decided to attempt retrograde techniques first. After administering heparin to a goal activated clotting time (ACT) of >350, a workhorse wire was advanced through a low-profile microcatheter into the first septal perforator. The wire was exchanged for a specialty wire that was used to cross septal collaterals. We had difficulty advancing the microcatheter into the septal perforator, as it was jailed with a previously placed stent (Figure 2). Here, we used a 1.5 mm x 20 mm TAKERU balloon to dilate the stent struts. We were able to advance the microcatheter into the septal perforator and into the distal vessel (Figure 3). The connection was made with a reverse controlled antegrade and retrograde tracking (R-CART) technique (Figure 4). Overlapping drug-eluting stents were placed and aggressively post dilated. Final angiography demonstrated no residual stenosis, dissection, or perforation (Figure 5). The patient was placed on dual antiplatelet therapy for six months.

Conclusion

TAKERU PTCA Balloon Dilatation Catheters are hydrophilic, and offer a low-entry profile that allows greater pushability and an increased ability to cross complex anatomy common in complex PCIs. 

Products Used

• Medtronic AL-1 guide catheter

• Medtronic EBU 3.75 guide catheter

• Teleflex 7 French TrapLiner

• Teleflex Turnpike LP 150

• Terumo Runthrough Coronary Guidewire

• Asahi Sion black coronary guidewire

• Asahi Mongo guidewire

• Asahi Gaia Next 3

• Terumo 1.5 mm x 20 mm TAKERU Balloon Dilatation Catheter

This case is sponsored by Terumo Interventional Systems.