Case 107: Manual of CTO Interventions - The Fifth Attempt

Challenging case of distal right coronary artery CTO that had been attempted without success four times previously. Triple injection (native RCA, left main, and LIMA graft) showed occlusion of the distal RCA with bridging collaterals and some septal and epicardial collaterals from the LAD. Retrograde crossing via septals failed, but we were able to advance a Suoh 03 guidewire via an apical LAD epicardial collateral. Initial retrograde crossing attempts failed, as did attempts to advance antegrade wires through the native RCA. Eventually after using multiple guidewires and the Carlino technique we were able to cross and successfully recanalize the CTO. The left radial guide catheter had kinked, requiring snaring and untwisting before it could be removed from the body.

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Thank you sir
Everyday i learn from you i hope to be one of your students