Case 256: Manual of CTO PCI - CTO PCI referral with CT only

A patient presented with exertional angina and was found to have a mid LAD on coronary CT angiography. The CTO had a blunt proximal cap at the takeoff of a diagonal branch, length of 26 mm, and good quality distal vessel. He was referred directly for PCI of the LAD CTO. Coronary angiography confirmed the CCTA findings. Antegrade wiring was done using a ReCross dual lumen microcatheter and Gaia Next 2 wire. A Gladius Mongo wire subsequently crossed the CTO into a septal branch at the distal cap. Using the ReCross a Gaia Next 2 wire was advanced parallel to the Gladius Mongo wire into the distal true lumen. After predilatation a stent was placed in the LAD but antegrade flow could not be restored. Another stent was placed distal to the first one restoring TIMI 3 flow in the LAD. There was a lesion in the proximal LAD with a minimum lumen area of 3.8 mm2 and large lipid content per OCT that was also stented with an excellent final result.

[@tom11298]

update to date, innovative and evidence based practice!
Using: data from PREVENT, using CT for planning and reducing number of procedures for the patient (discomfort, radiation),
and finally utilizing high resolution OCT. Well-Done 👍

[@shangz0216]

Thanks for the excellent case sharing.

[@fatherabdul]

Happy Friday Manos
Abdul