RCA CTO Intervention.

cto pci to rca advised in 2019 but refused by pt.
now again presented with CCS III angina.
on CAG mid RCA cto. LAD ostial ambiguous lesion and tight ostial lesion of RI.
MPI advised.
there was severe reverse able ischemia in inferior and inferior apical segment and mild ischemia elsewhere.
so cto rca done.
XT then gaia 2nd wire used initially sub intimal then redirected into true lumen.
MC failed to cross. sc 1.0 balloon used for predil then MC re advanced and gaia exchanged with workhorse wire.
predil, stent and post dilation.
distal severe diffuse disease subjected r
to GDMT.