Use of Export Thrombus Aspiration Catheter as a Dual Lumen Catheter for Antegrade LAD CTO Wiring With Side Branch

A 50-year-old female patient presented with class III angina for 6 months, positive stress test, and a prior CT angiogram suggestive of 3-vessel disease. Coronary angiogram showed disease of the distal ramus intermedius, proximal circumflex, and calcific chronic total occlusion (CTO) of proximal left anterior descending (LAD) artery (Figure, A & B; Videos 1, 2) with a Japanese (J)-CTO score of 2. She was planned for percutaneous coronary intervention of LAD CTO using a 6-French (F) Judkins right guide catheter from right radial and a 7-F extra-backup catheter from right femoral access.

A Finecross microcatheter (Terumo) and a Fielder XTA wire (Asahi) were used antegrade, however there was subintimal passage of the wire (Figure, C). Parallel wire technique was used, and another Fielder XTA wire was inserted into the first diagonal (D1) branch (Figure, D) near the distal CTO cap but was unable to pierce the distal cap. This wire in D1 was replaced with a balanced middle-weight wire via the microcatheter.

In the absence of a dual lumen microcatheter on shelf, an Export Advance thrombus aspiration catheter (Medtronic) was advanced over D1 wire through the rapid exchange port. Fielder XTA wire was introduced through the over-the-wire port, which resulted in successful antegrade crossing of the LAD (Figure, E; Video 3). A 145-cm DOC wire extension was used to remove the thrombus aspiration catheter over the LAD wire followed by routine removal of the monorail segment. The lesion was subsequently dilated with 1 x 10-mm and 2.5 x 15-mm balloons. Intra-vascular ultrasound (IVUS) was used to assess the vessel diameter, and a 2.75 x 38-mm Xience Prime stent (Abbott) was deployed from the ostial to mid LAD and post-dilated with 2.75 x 15-mm and 3.25 x 12-mm non-compliant balloons with good angiographic and IVUS results (Figure, F; Video 4).

Affiliations and Disclosures

From the Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, India.

Disclosures: The authors report no financial relationships or conflicts of interest regarding the content herein.

Address for correspondence: Kewal Kanabar, MD (AIIMS, New Delhi), DM (PGIMER, Chandigarh), Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad 380016, India. Email: kewal.kanabar14@gmail.com