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(A) Left coronary artery (right anterior oblique view). Coronary angiogram showed chronic total occlusion at the proximal portion of LAD. (B) RCA (left anterior oblique view); collaterals were from the RCA via the septal channel (Rentrop I). The RCA had severe stenosis with heavy dense calcium. The arrows in the figures show the lesions.
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Aortography revealed chronic total occlusion from terminal aorta to both external iliac arteries with heavy calcification. The arrows in the figures show the lesions.
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Although revascularization for the RCA should be taken into consideration, aortography revealed chronic total occlusion between the terminal aorta and both external iliac arteries (Fig. 2).
Guide wire passed through the occlusion site from retrograde approach. Two stents (E-Luminexx 10.0 x 120 mm) were implanted with the kissing technique.
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After stent implantation, post-dilation was performed with a Jackal RX 9.0 x 80 mm balloon (Kaneka Corporation, Osaka, Japan) at 10 atm (Fig. 3).
(A) PCI was performed by inserting a 6 Fr sheath from the right radial artery and IABP from the right common femoral artery. (B) After rotational atherectomy, Promus Element 3.5 x 24 mm and Promus Element 3.0 x 24 mm were implanted in the RCA with the guidance of IVUS.
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At seven days after EVT, percutaneous coronary intervention (PCI) was performed by inserting a 6Fr sheath from the right radial artery and IABP from the right femoral artery via a 7Fr sheath (Fig. 4A). Apex 3.5 x 12 mm (Boston Scientific Corporation, Miami, USA) (Fig. 4B).