Daniele Forlani

Civil Hospital “Holy Spirit” Pescara, Italy

Title: Ostial Chronic Total Occlusion (CTO) of LAD in a very young patient: the role of IVUS to plane a safe and succesfull procedure

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Biography

Dr. Daniele Forlani carries out interventional activities from 2005. In this years he participate to some course to improve knowledge in IVUS, OCT, FFR and iFR, Laser, Rotablator and many course for complex PCI. He is dedicated to percutaneous CTO recanalizations and he has followed a training for antegrade and retrograde procedures from 2012 to 2016 under the proctoring of dr. Roberto Garbo. During his training Dr. Forlani took part in several antegrade and retrograde ordinary and complex CTO procedures performed in Turin, in his Center and in other hospitals. Furthermore, he followed in Turin the 2011 meeting focused on the use of IVUS in CTO procedures, the 2012 and 2013 editions of the CTO Summit in Turin and he was invited as a case review presenter in the 2014, 2015 and 2016 edition and in 2015 and 2017 edition he won the best clinical case presentation. He was speaker in several international meeting in (GISE, PCR, TOBI, CTO summit, Gulf-PCR) and poster presenter in other important convention (ACC, SCAI, TCT). In 2020 he was awarded as the best clinical case in CTO meeting of Italian Society of Interventional Cardiology (GISE).He achieved the Universitary Master of II level in Interventional Cardiovascular and Structural Cardiology of “Scuola Universitaria Superiore Sant’Anna di Pisa”.

Abstract

A young man 48 years old with hypercolesteorlmia. That have some chest pain from severals years. He performed an exercise stress test that results doubt in symptoms and with a normal ECG. Then a TC coronary angiography demostrate a sub-occlusive occlusion of proximal LAD with a poor distal portion.The coronary angiography confirm the occlusion of LAD with some collateral from marginal branch and from right coronary artery.At ventriculography an hypo-akinesia of anterior, lateral and apical wall with an ejection fraction of 45%. Stress echo demostrate a vitality of lateral and anterior wall at 10 mcg of dobutamine.So we decide to plan a CTO and we calculate a J-CTO score that was 2 (presence of calcification and occlusion lenght more than 20 mm).We study the PRO antegrade (tapered CTO,a good ramus for ivus guided cap’s puncture)  and CONTRO antegrade ( ostial LAD CTO near the left main and the reentry point on distal cap is on a trifurcation) and the PRO retrograde (some good septal not so angled to navigate and the diagonal brach is connect to LAD from retrograde injection) and CONTRO retrograde (many attention of re-entry point on ostial LAD,to avoid a dissection of left main) and at the end we decided to start with retrograde approach and prepare the antegrade for the reentry (combined approach).At the end we have a success to recanalize the LAD from a pure retrograde with a IVUS guidance antegrade reentry on ostial LAD.At the end we think that to plan strategy is the most important thing during a CTO procedure, combined strategy to change from retrograde to anterograde approach is very usefull. The knowledge of materials can make the difference and at the end the role of ivus during a CTO is very usefull to guide the procedure and avoid complication.