PMC3705791_01
Diffusely diseased LAD with a 70% stenosis in the mid third with an occluded OM1.
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fig1
TIMI 0 flow (Figure 1).
Nonselective injection of RCA.
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fig2
The RCA was anterior in origin and nonselective coronary injection showed a patent stent (Figure 2).
Crossing the LCX.
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fig3
The wire crossed the proximal subsection of the left circumflex (LCX) with support (Abbott TREK 2.0 mm x 15 mm coronary dilatation catheter) (Figure 3). There was a resultant type B coronary dissection of the mid subsection of the proximal LCX.
Type B dissection of proximal LCX.
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fig4
A secondary type B coronary dissection was noted in the mid subsection of the mid third of the OM1 (Figure 4).
Type B dissection of mid OM1.
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fig5
IV Eptifibatide infusion was started to stabilize the dissection plane with a plan to reattempt the CTO in 72 hours (Figure 5).
Coronary AV fistula (OM1 to coronary sinus).
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fig6
Selective left coronary angiography showed a coronary artery (LCX) to coronary sinus fistula (Figure 6).