Conquering the obstacles during the intervention of a proximal chronic total occlusion of right coronary artery with a concurrent significant ostial stenosis: a case report

Abstract

Percutaneous coronary intervention (PCI) on a proximalchronic total occlusion (CTO) of the right coronary artery(RCA) with concurrent ostial stenosis can be challengingbecause of the significant difficulty in properly engagingthe catheter and providing stable support during theprocedure. We report the case of a 57-year-old man withchronic coronary syndrome who underwent an electivePCI at the Dr. Soetomo General Hospital in Surabaya, onApril 13th, 2022. At the beginning of the procedure, therewas difficulty in intubating the RCA, which required theguide catheter replacement. The angiography revealed asignificant lesion at the ostium, a CTO at proximal to mid-RCA with bridging collaterals, and a significant distallesion. Several strategies to improve guiding cathetersupport during PCI are using large and supportive shapeguide catheters, deep guide catheter intubation, extrasupport wire, microcatheter and guide catheterextension.The risk of pressure dampening and ischaemia uponengagement should always be kept under consideration.Keywords: Percutaneous, Coronary Intervention,Catheters, Vascular Diseases, Ischemia, Angiography,Intubation, Intratracheal