Case 228: Manual of CTO PCI - "Rendez-vous"

A patient with ischemic cardiomyopathy was referred for PCI of a RCA CTO. The RCA CTO had a blunt proximal cap, length of approximately 30 mm, diffusely diseased distal vessel and septal+epicardial collaterals. Antegrade wiring with a Fielder XT-A and Gladius Mongo failed. A Suoh 03 crossed through a septal collateral but a Caravel microcatheter could not cross. Using a Trapliner a Corsair XS microcatheter was delivered to the distal cap. A retrograde Gladius Mongo was advanced to the proximal cap and formed the target for an antegrade Gaia Next 2 wire that crossed to the mid RCA. The Gladius Mongo was withdrawn and the Gaia Next 2 wire was advanced inside the Corsair XS microcatheter (rendez-vous technique). Using a Sasuke microcatheter a wire was advanced to the PDA followed by successful balloon angioplasty and stenting.