Staged PCI of Diffuse Totally Occluded LAD CTO using Antegrade/Retrograde Technique

68-year-old male presented with known 3V CAD (refused CABG in the past as developed CVA post Cath), severe CCS Class III angina and positive SPECT MPI. A Cardiac Cath on May 10, 2022 revealed 3 V CAD and 50% distal LM: 80% prox LAD with long diffuse CTO mid LAD and distal vessel fills via antegrade bridge and retrograde RCA collaterals (J-CTO Score 3), 80% mid RCA, 70% LPL with SYNTAX Score of 33 and LVEF = 40%. Patient underwent successful intervention of mid RCA using Promus Elite DES. Patient is now planned for staged PCI of LAD CTO using antegrade/retrograde recanilzation and IVUS interrogation of moderate LM lesion.

[@rajthapa1997]

Great teaching as always. Thank you

[@drhasham]

Great case and teaching points. Appreciate the healthy disagreements between the operators - highlights that there is not necessarily a perfect way to approach any lesion. Thank you for sharing these with the interventional community.

[@wilzboyz]

Great case. Always pick up a few ideas. Do you check the LVEDP before starting to reduce the risk of CI-AKI? As per the Poseidon trial.

[@cchung1098]

GOOD JOB

[@shahruhabdirimov3272]

Very good case, I can the wire Fielder always find microchannels, and secondly this case your isn't true Chronicale occlusion, it's subocclusion