Abstract
A 70-year-old man with a medical history of hypertension, dyslipidemia, and diabetes was referred to our hospital for effort angina. Coronary angiography revealed chronic total occlusion (CTO) of the proximal right coronary artery (RCA) that had been collateralized by septal branches from the left anterior descending coronary artery, left circumflex coronary artery, and an antegrade bridge. Three everolimus-eluting stents (Xience-Alpine: 3.0 × 38 mm, 2.75 × 38 mm, and 2.5 × 38 mm; Abbott-Vascular Co., Abbott Park, IL, USA; Fig. 1D, indicated by yellow lines) were implanted with stent overlap. Post-procedural angiography showed double-barrel flow through the RCA. Repeat angiography after 10 months showed double-barrel flow through the RCA, the stented lumen, and the non-stented lumen. Optical coherence tomography (OCT) demonstrated subintimal stenting. OCT revealed that the entry point from the true lumen (TL) was the proximal segment of the RCA, and the re-entry point to the TL was the distal segment of the RCA. Additionally, OCT showed smooth and thin neointimal proliferation inside the deployed stent, and there was no evidence of an intraluminal thrombus. To the best of our knowledge, this is the first report describing a subintimal stenting of CTO lesion involved with double-barrel coronary artery with OCT assessment.
A 70-year-old man with a medical history of hypertension, dyslipidemia, and diabetes was referred to our hospital by his primary care physician for the management of effort angina. Coronary angiography revealed chronic total occlusion (CTO) of the proximal right coronary artery (RCA) that had been collateralized by septal branches from the left anterior descending coronary artery, left circumflex coronary artery, and an antegrade bridge ( Fig. 1 -A ). The lesion was penetrated using subintimal guidewire tracking ( Fig. 1 -B). Finally, the cardiologist traversed the lesion to reach the distal segment of the RCA, using a Conquest Pro 30 Coronary guidewire (Asahi Intecc; Fig. 1 -C). Three everolimus-eluting stents (Xience-Alpine: 3.0 × 38 mm, 2.75 × 38 mm, and 2.5 × 38 mm; Abbott-Vascular Co., Abbott Park, IL, USA; Fig. 1 -D, indicated by yellow lines) were implanted with stent overlap, followed by post-dilation with a 3.0-mm noncompliant balloon. Post-procedural angiography showed double-barrel flow through the RCA ( Fig. 1 -E, F, indicated by red arrows). Repeat angiography after 10 months showed double-barrel flow through the RCA, the stented lumen, and the non-stented lumen ( Fig. 2 -A and 1 ). Optical coherence tomography (OCT) demonstrated subintimal stenting ( Fig. 2 -a, b, c, d, e, f). OCT revealed that the entry point from the true lumen (TL) was the proximal segment of the RCA, and the re-entry point to the TL was the distal segment of the RCA ( Fig. 2 -a, f). Additionally, OCT showed smooth and thin neointimal proliferation inside the deployed stent ( Fig. 2 -a, b, c, d, e, f), and there was no evidence of an intraluminal thrombus and significant malapposed stent struts. Furthermore, adenosine perfusion cardiac magnetic resonance imaging revealed no evidence of cardiac ischemia in the RCA territory.
