Complex CTO PCI in retrograde (failure)

Case summary

Age: 59 year old
Gender: male
Type II DM treated with oral drugs
Hypertension; Dyslipidemia
Morbidity obese (BMI 35)
Previous smoking habit
2009: CABG with LITA on LAD, SVG on D1, SVG on MO1, SVG on PDA
Stable angina (CCS III)
Nuclear perfusion imaging: severe ischemia on inferior and anterior wall
Occluded LITA; occluded all SVG
LAD: proximal occlusion
MO1: ostial occlusion
RCA: mid occlusion
SYNTAX score: 25 (RCA CTO 10pts)
JCTO score 2: calcium and >20 mm

Strategy

ACCESSES:
Radial XB 3.5 6Fr 90 cm
Femoral AL1 7Fr 100 cm; long sheath

APPROACHES:
Antegrade approach with guidewire escalation (starting with GAIA 3rd); Turnpike Gold microcatheter
Antegrade dissection reentry
Retrograde approach

Protocol