Case 44: PCI Manual - Wiring in STEMI

A patient presented with anterior STEMI and was found to have proximal LAD occlusion on coronary angiography. Wiring with a workhorse guidewire failed to cross the occlusion. A Micro 14 microcatheter was used to support the guidewire, followed by attempts with multiple guidewires, such as Fielder FC, Fielder XT, Fielder XT-A, Gladius, Pilot 200. Multiple angiographic projections were used to determine the course of the occluded vessel. Finally, using the Micro 14 and a Gaia 2nd guidewire the occlusion was successfully crossed followed by angioplasty and stenting, restoring antegrade TIMI 3 flow.

[@micger]

Thank you, it's very educational

[@mahnazriahi6616]

An interesting case (video) for angioplasty CTO in (irancardiology)

[@fabioccarvalho73]

Excellent final result!! But I think that, particularlly in this case, a LV angiogram prior to PCI could give us some additional information. It seemed to be a large anterior aneurysm in last angiography, maybe no viable myocardium in this wall

[@TheNEF11]

Very interesting case. My way to go for STEMI with totally occluded LAD is the LAO 90°/0° view. Works in almost 95% of the cases to find the right direction of the LAD and one of the best view for making sure I am not in a septal or in a diagonal! The radiation dose is the biggest disadvantage for this angulation tho

[@BarrieLouis]

Thank you!

[@schiefix]

Of course an LAO cranial would be the way to differentiate between LAD and Diagnoals (LAD being the "left-most" straight down to 6 o´clock vessel). Not sure why one would work in this odd projection with lots of overlay.

[@ruotianli8785]

Can it be that the diagonal branch is occluded in the end? Have you tried to wire that branch?

[@mahnazriahi6616]

An interesting case (video) for angioplasty CTO in (irancardiology)