Case 7: Manual of CTO Interventions - In-stent CTO with bifurcation at the distal cap

Right coronary artery in-stent CTO with bifurcation at distal cap. Used CenterCross catheter to penetrate proximal cap with Confianza Pro 12 guidewire. Crossed with antegrade knuckled Fielder XT into posterolateral branch. Had to use retrograde crossign to recanalize PDA. After mini-crush both the posterior descending artery and the posterolateral branch were successfully recanalized.

[@AhmedElborae]

Great Thanks for this excellent case, I want to know your opinion about using drug eluting balloon for in stent CTO?

[@manosbrilakis]

I do not have any experience with drug coated balloons as they are not approved in the US. As long as a nice final angiographic result is achieved, use of DCB is likely advantageous as it limits the layers of metal in the vessel.