Case 235: Manual of CTO PCI - Easy CTO?

A patient was referred for PCI of a LAD CTO due to angina. The CTO was short (~5 mm) with blunt proximal cap and diffusely diseased distal vessel and was filling via both septal and epicardial collaterals from the RCA. Antegrade crossing attempts failed. Retrograde crossing of a septal branch was successful using a Suoh 03 wire, but the wire entered the diagonal branch. Repeat antegrade crossing attempts with a Gaia Next 2 wire resulted in extraplaque crossing. Parallel wiring failed as did Stingray re-entry. The Stingray balloon was advanced more distally in the LAD and re-entry was achieved using the “stick and drive” technique with an Astato 20 wire. Using a Sasuke dual lumen microcatheter a wire was advanced into the diagonal branch, followed by successful stenting of the LAD.

[@shokhrukhabdirimov6376]

Cto is never easy, for any case we should be with respect

[@svijaykumarreddy1242]

Initially we should start with dual lumen catheter when the wire is going repeatedly to branch

[@shangz0216]

Thanks for the excellent case sharing.

[@tom11298]

Certainly, each angiogram or even a "simple non CTO-PCI" should be approached with utmost attention and diligence

[@user-ny7hj6of5r]

Many thanks for your beautiful presentation. What is the protocol for prolonged ballooning?

[@NikhilJha89]

What about Open sesame?

[@manosbrilakis]

Great point - open sesame can certainly be used when there is a side branch next to the proximal cap.

[@NikhilJha89]

No case is easy