Case 273: Manual of CTO PCI - Success but...

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A patient presented with exertional dyspnea and was found to have anterior ischemia on stress testing. Coronary angiography showed a mid LAD CTO without significant disease in the RCA and the circumflex. Coronary CT angiography showed heavy calcification at the proximal cap. Antegrade wiring was successful with a Gaia Next 2 wire but the lesion could not be crossed with a microcatheter. After dilation with a Sapphire 1.0 mm balloon and a Takeru 1.5 mm balloon the microcatheter crossed the lesion. A Viper wire flex tip was inserted followed by the orbital atherectomy, balloon angioplasty and stenting with an excellent final result. The arterial waveform had a delayed upstroke. A catheter was advanced to the left ventricle showing severe aortic stenosis. The patient was referred for aortic valve replacement.
Category
Cardiology
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