Abstract:

Introduction: in recanalization of chronic total occlusions (CTO), contralateral injection is the most important stage, significantly increasing chance of technical success and reducing the incidence of complications.

Materials and methods: 60-year old male patients, with angina pectoris, 3 functional class. After the examination, decision was made to conduct coronary angiography. According to coronarography, occlusion of proximal third of right coronary artery (RCA) was revealed, with collateral filling from the left coronary artery (LCA) R2 and the development of collaterals CC0. According to the scintigraphy data, a «viable myocardium» was detected behind the occlusion zone. Patient underwent mechanical recanalization of RCA with contralateral contrast-agent injection, balloon angioplasty, drug-eluting stents (DES) 3,5?38 mm and 3,5?24 mm were sequentially implanted with a good angiographic result.

Result: contralateral contrast-agent injection during this recanalization helped to avoid complications associated with perforation of lateral branches and greatly facilitated the positioning of guidewire into true lumen of artery. Patient continued military service under the contract.

Conclusion: in case of proper examination, management, and selection of patients, recanalization of chronic occlusion can significantly improve patient's quality of life. It is worth noting that for many patients, social indications are also important, such as the possibility to continue military service or work in a specialty. However, medical indications should be considered first, since unjustified recanalization of chronic occlusion will not improve patient's condition, and a number of serious complications may occur during the operation.