Case 18: Manual of CTO Interventions - Unable to engage CTO vessel

Proximal right coronary artery CTO with severe calcification. The right coronary artery could not be engaged with a guide catheter. Retrograde crossing was performed using septal surfing, two microcatheters (due to deformation of the first one during crossing attempts) and multiple stiff guidewires. The retrograde guidewire was snared and externalized, but the lesion could not be crossed with a balloon. After laser the lesion was successfully crossed with a balloon, predilated and successfully stented with optimization using IVUS guidance.

[@felipegonzalez6532]

Extraordinary case. Magnificent interventionist. Wonderfull teaching. Congratulations Dr. Manos Brilakis.

[@aymantantawy1475]

Wonderful case. Thank you Dr. Brilakis