Case 243: Manual of CTO PCI - CTO & bifurcation

A patient was referred for PCI of an LAD CTO due to exertional angina. The CTO had a blunt proximal cap after the takeoff of a large diagonal branch, length of approximately 25 mm, good quality distal vessel and septal collaterals from the right posterior descending artery. Antegrade wiring was performed using a Venture angulated microcatheter and a Gaia Next 2 but the wire went extraplaque. Retrograde crossing was successful through a septal collateral into the proximal true lumen and the antegrade guide catheter. IVUS confirmed that crossing was intraplaque. Using a Sasuke dual lumen microcatheter a workhorse wire was advanced to the distal LAD, followed by successful stenting using the DK crush technique. The patient had significant symptom improvement.