Excimer laser atherectomy in an uncrossable long chronic total occlusion through the subintimal space
Bibliographic record
Abstract
We present a successfully chronic total occlusions (CTO) coronary recanalisation with the subadventitial space by excimer laser atherectomy (ELCA) adjunctive therapy. Angiogram revealed non-significant diffuse disease of the left coronary system with a complex long proximal right coronary artery (RCA) CTO (J-CTO score 4) and collaterals (Rentrop Grade 2 and Werner classification CC1) from the septal branches (Figure 1, Panel A). CTO PCI of the RCA was then indicated and planned. Initially, antegrade approach and a retrograde approach technique were attempted without success. Thereafter, a rescue Antegrade Dissection Reentry strategy (ADR) was applied. A Pilot 200 (Abbott) was advanced in a knuckle fashion in subintimal space reaching the distal cap. A Conquest Pro 12 (Asahi) successfully re-entered true lumen in posterolateral (PL) (Figure 1, Panel B). However, none balloon was able to be advanced thereafter. Thus, a Spectranetics ELCA 0.9 mm X-80 with simultaneous saline flush, frequency 80 Hz and fluence 80mJ/mm2 (Figure 1, Panel C) was applied successfully. A workhorse wire was advanced into the posterior descendent artery (PDA) followed by a non-compliant Trek balloon (Abbott) 2.5 20 mm to PL. Pre-dilatation followed by stenting was performed supported by a Guideliner (Teleflex) extension catheter. A total of three drug-eluting stents Synergy (Boston Scientific) were implanted with good angiographic result (Figure 1, Panel D). Intravascular ultrasound showed that the wire went through the subintimal space (red arrow) in both mid and distal RCA (Figure 1, Panel E), with appropriate debulking of the subintimal lesion (red arrow) and haematoma around the vessel (blue arrow) (Figure 1, Panel F), and then re-entering near the bifurcation with resolution of the haematoma (red arrow) and with optimal stenting result (Figure 1, Panel G).
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".