By Eugene B. Wu, MRCP, MD
Dr Ikari and I were enjoying the wonderful hospitality upon Bill Lombardi’s boat at the Peacehealth CTO course in lovely Bellingham, when the topic of conversation turned rather quietly to slender PCI. As some of you may know, Dr. Ikari is slender, he works with my friend, Yoshimachi (“Mr Slender Club” at Tokai). Over dinner, we got serious into the topic and Ikari calculated that it would be possible to use the Bridgepoint Stingray device in a 5 French Ikari Catheter. Boosted by beer-enhanced interventionist‘s bravado, I quickly announced that I would do such a case to demonstrate slender Stingray.
Admittedly, I started doing more 5 French CTO PCI than I did before, hoping to find a case to sting, and soon enough, I found myself holding an XT wire in the subintimal distal to a mLAD CTO. I tried a UB3 without any luck and so, using the Corsair, I made a small channel for the stingray to pass. Usually, I would put a retrograde catheter to allow contra-lateral contrast injection, but after Corsair dilatation, the antegrade contrast flow was excellent. Nonetheless, retrograde injection should be the norm in CTO PCI. The Stingray went down easily and I managed and stick and swap for a pilot 150 long wire. It was easy to back the Stingray off the 300 cm pilot 150 and then switch out through the corsair for a workhorse wire. You can see the excellent angiographic results after stenting.
What do I make of it? It’s 2013, Tsuchikane is slimming down, Ikari is slender, and maybe its time for me to thin down a bit too?
Eugene B. Wu, MRCP, MD1 and Yuji Ikari, MD2
Journal of Invasive Cardiology, July 2013, volume 25, no. 7, pages E155-E158
1 – Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University Hong Kong, Hong Kong
2 – the Department of Cardiovascular Medicine, Tokai University School of Medicine, Kanagawa, Japan
Innovative case describes combining the advances in CTO PCI from the East and the West together for successful treatment and also demonstrates use of the Stingray system in a 5 French guiding catheter.