PMC9760791_01
(A) ATP stressed myocardial perfusion imaging (MPI) demonstrated ischemia in the anterior wall near the apex, inferior wall, posterior wall, and lateral wall of the left ventricle. (B) Routine MPI showed uniform myocardial distribution.
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F1
Electrocardiogram and treadmill test were normal while ATP stressed myocardial perfusion imaging (MPI) demonstrated reversible ischemia in the anterior wall near the apex and inferior, posterior, and lateral walls of the left ventricle (Figures 1A,B).
Angiography in left anterior oblique(LAO) 45  and cranial 25 : (A) total occlusion of the proximal LCX without calcification and collateral vessels from the LAD to distal LCX. (B) Internal diameter of the RCA was nearly average. (A) Angiography in right anterior oblique (RAO) 30 : LCX occluded at the proximal end, and distal blood supply has relied on collateral vessels; (B,C) Recanalization of occluded LCX using antegrade crossing technique; (D) Angiography after balloon angioplasty showed patent LCX; (E) DCB was attached to the LCX for 60 s; (F) Angiography of the LCX after DCB angioplasty.
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F2
Coronary angiography was performed and revealed a small coronary aneurysm (4.8 mm in diameter) in the LAD with severe calcification around the aneurysm wall, total occlusion of the proximal LCX without calcification, and collateral vessels from the LAD to the distal LCX (Figure 2A). The diameter of the RCA was near average with slight distortion in the main branch, suggesting a regression of previous aneurysms (Figure 2B). Asahi) microcatheter was then introduced to the opening of the LCX (Figure 2A). Afterwards, attempts were made to pass Sion/Fielder XT-R/Fielder XT-A guide wires (Asahi) through the occlusion, but all attempts failed. Ultimately, a Gaia3rd guidewire (Asahi) was successfully passed across the occlusion site (Figure 2B) to the distal LCX (Figure 2C). We gently performed pre-dilations of the occluded lesion with a 2.0 mm x 12 mm Emerge  PTCA balloon (Boston Scientific) (Figure 2D) and further dilations with a 2.5 mm x 30 mm paclitaxel-coated balloon (Bingo, Yinyi Biological) at 7 atm for 60 s (Figure 2E). The final coronary angiography showed that the occluded segment of the LCX was successfully recanalized, with the contrast agent evenly filling and no arterial dissection detected (Figure 2F).
One year after the PCI angiography showed good flow in the LCX. (A) Angiography in right anterior oblique15  and Caudal 15 ; (B) Angiography in left anterior oblique 45  and Cranial 25 .
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F3
Coronary artery angiography demonstrated good blood flow in the LCX (Figures 3A,B) and the complete blood count as within normal limits.