Case 247: Manual of CTO PCI - The 2nd attempt

A patient with prior CABG was referred for PCI of a right coronary artery CTO (the SVG to the RCA had occluded) due to exertional angina and dyspnea. Antegrade wiring attempts, including parallel wiring, resulted in extraplaque wire crossing. Retrograde attempts failed. The Stingray balloon was used to re-enter into the distal true lumen in the posterolateral. A knuckled Mongo wire was then advanced through a ReCross dual lumen microcatheter into the right PDA. After balloon angioplasty antegrade flow was restored but a distal vessel perforation was seen in a branch of the right posterolateral. The perforated branch was coiled with Axium coils and the procedure was stopped.
Two months later the patient returned for a 2nd attempt. There was antegrade flow into the right posterolateral branch but antegrade wiring failed. Eventually using the Stingray balloon and the stick and drive technique a wire was advanced into the right posterolateral, followed by successful stenting without attempting to recanalized the PDA during this attempt.

[@shangz0216]

Thanks for the excellent case presentation.

[@alekseyfoorkalo665]

Thank you for the great case. Why was the decision made to not attempt to recanalize PDA during the second procedure? Thank you!

[@pramodpc2206]

great case , sir

[@xx_thor_user_xx6326]

Can you do a session on right heart, nitric oxide study?