PMC7275241_01
(a) Coronary angiogram showing left coronary artery disease with chronic total occlusion (CTO) of the obtuse marginal 1 (OM1) branch of the left circumflex (LCx) artery. (b) Postcoronary intervention with restoration of TIMI 3 flow in the OM1 branch. (c) Coronary angiogram showing severe diffuse right coronary artery (RCA) disease. (d) Postcoronary intervention with restoration of TIMI 3 flow in RCA.
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TIMI-3 flow was demonstrated with no evidence of dissection or perforation (Figures 1(a)-1(d)).
PMC7275241_02
(a) Coronary angiogram showing severe disease in the left anterior descending (LAD) and left circumflex (LCx) arteries. (b) Postfirst stage of coronary intervention with restoration of TIMI 3 flow in the LAD and LCx. (c) Coronary angiogram showing severe diffuse right coronary artery (RCA) disease with CTO. (d) Postsecond stage of coronary intervention with restoration of TIMI 3 flow in RCA.
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CTO treated with an antegrade wire escalation technique and placement of a DES using modified T and small protrusion strategy with final bifurcation kissing balloon inflation (Figures 2(a) and 2(b)). CTO of RCA was seen with retrograde filling via LAD septals to the right posterior descending artery septals. In the "second stage," CTO at the ostial RCA was managed by successful deployment of two overlapping DES via an antegrade approach guided by intravascular ultrasound (IVUS) (Figures 2(c) and 2(d)).