Case 298: Manual of CTO PCI - SVG CTO PCI

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A patient had prior CABG with LIMA-LAD, SVG-Diagonal 1 and SVG-Diagonal 2. His SVG-Diagonal 2 subsequently occluded but he did well until 10 years later when he developed lifestyle-limiting angina. Coronary angiography showed occlusion of the SVG-Diagonal 1. He was referred for recanalization of the first diagonal CTO. The occluded SVG-Diagonal 1 was successfully crossed with a Pilot 200 through a Corsair microcatheter but the wire could not advance retrogradely and the origin of the first diagonal was unclear on angiography and IVUS. Eventually the SVG-Diagonal 1 was stented restoring antegrade flow. The patient developed acute stent thrombosis that was successfully treated with Penumbra thrombectomy and administration of nicardipine and cangrelor. He had resolution of angina and was feeling well 11 months later.
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Cardiology
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