Multidisciplinary Team at Fuwai Hospital, Beijing Successfully Performs Ultra-High-Risk Retrograde PCI for Left Main CTO

Multidisciplinary Team at Fuwai Hospital, Beijing Successfully Performs Ultra-High-Risk Retrograde PCI for Left Main CTO

Clinical Background

🏥 A patient was admitted with sudden severe chest pain and cardiogenic shock following a failed PCI attempt at an outside facility. Angiography indicated a CTO of the Left Main (LM) and LAD. The Right Coronary Artery (RCA) was the sole source of blood supply but was compromised by a >90% severe stenosis, leading to extreme hemodynamic instability.

Surgical Strategy

🔬 Following a comprehensive Multidisciplinary Team (MDT) evaluation, CABG was deemed a prohibitive surgical risk. The team elected to perform a high-risk PCI under Intra-Aortic Balloon Pump (IABP) support. The core strategy involved two phases: first, securing baseline perfusion by treating the RCA stenosis; second, establishing a retrograde channel via RCA collaterals to recanalize the LM.

Anatomical Reconstruction

⚙️ In the first phase, the team rapidly and precisely dilated two severe lesions in the RCA to prevent intraoperative sudden cardiac death. Subsequently, facing the formidable challenge of extremely tortuous collaterals, the retrograde wire successfully navigated into the true lumen using the parallel wire technique.

⚙️ To tackle the stumpless LM CTO, operators repeatedly reshaped the guidewire to locate the micro-channel. When sudden hemodynamic collapse occurred intraoperatively, the team promptly withdrew the devices to stabilize the patient.

⚙️ Overcoming the imaging challenge of severe vessel overlap by adjusting angiographic angles, the team ultimately achieved anatomical reconstruction of the occluded segment utilizing the kissing wire technique.

Outcomes & Media

📊 Following 4 hours of meticulous intervention, antegrade flow was instantly restored post-balloon dilation and stenting. Post-operatively, the patient's cardiac function steadily recovered, and he is currently safely out of the critical period.