Case 287: Manual of CTO PCI - LAD CTO with poorly visualized distal vessel

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A patient was referred for LAD CTO PCI due to angina that was refractory to medical therapy. The LAD CTO has a clear proximal cap but the distal vessel was poorly visualized on coronary angiography. Coronary CT angiography showed good quality distal LAD with the distal cap being proximal to a large first diagonal. There was non-circumferential calcification within the occlusion. A Sion black supported by a Corsair microcatheter was advanced into a distal vessel. On the RAO projection the vessel was going up during systole suggesting that it was a diagonal. After angioplasty with a 2.0 mm balloon antegrade flow was restored in both the LAD and the diagonal. The LAD was wired using a Sasuke dual lumen microcatheter. After provisional stenting of the LAD a nice final result was achieved.
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Cardiology
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