EBC - ON DEMAND
Use of a microcatheter to overcome complex side branch access
European Bifurcation Club 2014, EBC 2014 – Bordeaux, France
CASES: TIPS & TRICKS AND COMPLICATIONS
Use of a microcatheter to overcome complex side branch access
Author: Gregor Leibundgut, MD, Kantonsspital Baselland, Switzerland
PATIENT
- 84-year old female patient with unstable angina
- Three vessel disease
- 50% diameter stenosis of the mid RCA
- 80% stenosis of the distal LCX
- true bifurcation lesion of Medina class 1,1,1 of the mid LAD and first diagonal branch (RD1)
- The bifurcation of the LAD and a large diagonal branch also included a large aneurysm that prevented swan neck technique
PROCEDURE
- Direct guide wire advancement into the distal LAD was impossible due to an unfavourable angle of the lesion (continuously prolapsing into aneurysm).
- Making a loop turn in the aneurysm provided enough backup to advance a floppy wire into the distal LAD.
- Exchanged floppy wire over a FineCross microcatheter by an extra support wire which then straightened the lesion and the guide wire loop in the aneurysm.