Abstract
Side branch occlusion, which was one of the common complications in percutaneous coronary interventions, was closely associated with cardiac death and myocardial infarction. Clinical guidelines also support the importance of preservation of physiologic blood flow in SB during PCI to bifurcation lesions. In order to avoid side branch occlusion during stent implantation, we often performed the jailed wire technique, in which a conventional guide wire was inserted to the side branch before stent implantation to the main vessel. However, the jailed wire technique could not always prevent side branch occlusion. In this case report, we described a case of 72-year-old male suffering from angina pectoris. Coronary angiography revealed the diffuse calcified stenosis in the proximal and middle of left anterior descending coronary artery, and the large diagonal branch originated from the middle of the stenosis. To prevent side branch occlusion, we performed a novel side branch protection technique by using the Corsair microcatheter (Asahi Intecc, Nagoya, Japan). In this case report, we illustrated this “Jailed Corsair technique”, and discussed the advantage compared to other side branch protection techniques such as the jailed balloon technique.
Highlights
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Side branch occlusion is closely associated with cardiac death and myocardial infarction during percutaneous coronary intervention.
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A novel side branch protection technique using Corsair microcatheter (Jailed Corsair Technique) is illustrated.
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Jailed Corsair Technique has advantages such as less risk of side branch dissection as compared to jailed balloon technique.
1
Introduction
Side branch (SB) occlusion is one of the common complications in percutaneous coronary intervention (PCI) . SB occlusion was closely associated with cardiac death and myocardial infarction . Clinical guidelines also support the importance of preservation of physiologic blood flow in SB during PCI to bifurcation lesions . To avoid SB occlusion, we often performed the jailed wire technique, in which a conventional guide wire was inserted to the SB before stent implantation to the main vessel. However, the jailed wire technique could not always prevent SB occlusion.
Recently, the jailed balloon technique has been applied to some bifurcation lesions for the purpose of SB protection . In the jailed balloon technique, a double marker semi-compliant balloon was advanced into the SB just distally into the SB ostium, and the balloon was inflated to low pressure . Then, the main vessel stent balloon was inflated with nominal pressure, and both main vessel stent balloon and SB balloon were deflated together and removed . The risk of SB occlusion would be less in the jailed balloon technique as compared to the simple guide wire protection to SB (jailed wire technique) . However, we may hesitate to use the jailed balloon technique, because there are several concerns such as SB balloon entrapment or SB balloon rupture. Furthermore, ostium of SB may have dissection following SB balloon inflation. We present a case with a bifurcation lesion, which was treated by a novel side branch protection technique. We used a Corsair microcatheter (Asahi Intecc, Nagoya, Japan) for protection of the SB during stent implantation to the main vessel.
2
Case report
A 72-year-old male with stable angina pectoris was referred to our department for PCI to the diffuse calcified stenosis in the proximal and middle of left anterior descending (LAD) coronary artery. A 7-Fr CLS 3 SH guide catheter (Boston Scientific, Natick, MA, USA) was inserted to left coronary artery via right femoral artery ( Fig. 1 A). Because there were moderate to severe calcifications at the proximal segment of LAD, we planned rotational atherectomy to the lesion. We advanced a conventional guide wire with a Corsair Pro (Asahi Intecc, Nagoya, Japan) microcatheter, and then exchanged the conventional guide wire for the rotawire floppy (Boston Scientific, Natick, MA, USA). We advanced the 1.25 mm burr to the lesion ( Fig. 1 B), and exchanged the rotawire floppy for the conventional guide wire again. After balloon dilatation using 2.0 × 12 mm non-compliant balloon, we performed an intravascular ultrasound, which showed circumferential superficial calcification with a crack ( Fig. 1 C). We inserted another conventional guide wire to the large diagonal branch, and underwent additional balloon dilatation using a 2.5 × 9 mm scoring balloon (Lacrosse NSE, Goodman, Nagoya, Japan). We inserted the Corsair microcatheter to the diagonal branch before stent implantation. A 2.25 × 38 mm Everolimus eluting stent (Synergy, Boston Scientific, Natick, MA, USA) was implanted to the distal segment of LAD. A 2.5 × 38 mm Everolimus eluting stent (Synergy, Boston Scientific, Natick, MA, USA) was implanted to the middle to proximal segment of LAD by minimum inflation pressure (8 atm) with the jailed Corsair ( Fig. 1 D). After removal of the stent balloon, the jailed Corsair was removed with rotating the Corsair shaft. Only small friction was felt during removal of the jailed Corsair. Coronary angiography just after the removal of the jailed Corsair showed the patent diagonal branch without ostial dissection ( Fig. 1 E). Another conventional guide wire was advanced to the diagonal branch from inside of the implanted stent by using a double layer lumen microcatheter (Crusade, Kaneka, Osaka, Japan), and the original jailed wire was removed without any friction. We performed post dilatation using 2.5 mm balloons. Final angiography showed the fully expanded stents and the patent diagonal branch ( Fig. 1 F). The scheme of the Jailed Corsair technique is shown in Fig. 2 .
2
Case report
A 72-year-old male with stable angina pectoris was referred to our department for PCI to the diffuse calcified stenosis in the proximal and middle of left anterior descending (LAD) coronary artery. A 7-Fr CLS 3 SH guide catheter (Boston Scientific, Natick, MA, USA) was inserted to left coronary artery via right femoral artery ( Fig. 1 A). Because there were moderate to severe calcifications at the proximal segment of LAD, we planned rotational atherectomy to the lesion. We advanced a conventional guide wire with a Corsair Pro (Asahi Intecc, Nagoya, Japan) microcatheter, and then exchanged the conventional guide wire for the rotawire floppy (Boston Scientific, Natick, MA, USA). We advanced the 1.25 mm burr to the lesion ( Fig. 1 B), and exchanged the rotawire floppy for the conventional guide wire again. After balloon dilatation using 2.0 × 12 mm non-compliant balloon, we performed an intravascular ultrasound, which showed circumferential superficial calcification with a crack ( Fig. 1 C). We inserted another conventional guide wire to the large diagonal branch, and underwent additional balloon dilatation using a 2.5 × 9 mm scoring balloon (Lacrosse NSE, Goodman, Nagoya, Japan). We inserted the Corsair microcatheter to the diagonal branch before stent implantation. A 2.25 × 38 mm Everolimus eluting stent (Synergy, Boston Scientific, Natick, MA, USA) was implanted to the distal segment of LAD. A 2.5 × 38 mm Everolimus eluting stent (Synergy, Boston Scientific, Natick, MA, USA) was implanted to the middle to proximal segment of LAD by minimum inflation pressure (8 atm) with the jailed Corsair ( Fig. 1 D). After removal of the stent balloon, the jailed Corsair was removed with rotating the Corsair shaft. Only small friction was felt during removal of the jailed Corsair. Coronary angiography just after the removal of the jailed Corsair showed the patent diagonal branch without ostial dissection ( Fig. 1 E). Another conventional guide wire was advanced to the diagonal branch from inside of the implanted stent by using a double layer lumen microcatheter (Crusade, Kaneka, Osaka, Japan), and the original jailed wire was removed without any friction. We performed post dilatation using 2.5 mm balloons. Final angiography showed the fully expanded stents and the patent diagonal branch ( Fig. 1 F). The scheme of the Jailed Corsair technique is shown in Fig. 2 .
