Скачать или смотреть Case 225: Manual of CTO PCI - antegrade wiring works

A patient with prior CABG and occluded SVG-PDA was referred for PCI of a RCA CTO after 3 prior failed PCI attempts. The CTO had a clear proximal cap with an acute marginal originating next to it, 20-30 mm occlusion length and distal vessel filling via both ipsilateral and contralateral epicardial collaterals. Antegrade wiring was attempted with a Fielder XTA without success, but a Gaia Next 2 successfully crossed the proximal cap. The Gaia Next 2 was exchanged for a Gladius Mongo that successfully crossed into the distal true lumen as confirmed by contralateral injection. The proximal cap was uncrossable by the Turnpike LP microcatheter but was successfully crossed with a Sapphire balloon, followed by microcatheter crossing, exchange for a workhorse wire, balloon angioplasty, IVUS and stenting with a nice final result.