PMC3915968_01
Right coronary artery chronic total occlusion located in proximal part, length approximately 20 mm
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Coronary angiography disclosed chronic occlusion of the right coronary artery (Figure 1) and a concomitant attempt to restore the patency of the vessel was made.
Dissection in proximal part of right coronary artery totally occluding collaterals (TIMI 0)
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During an attempt to cross the occlusion with a guidewire a dissection in the proximal part of the artery occurred leading to complete cessation of flow through the ipsilateral circulation (Figures 2 and 3).
Contralateral contrast media injection to left coronary artery makes visible distal part of RCA (Rentrop scale 2, Werner scale 2)
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During an attempt to cross the occlusion with a guidewire a dissection in the proximal part of the artery occurred leading to complete cessation of flow through the ipsilateral circulation (Figures 2 and 3).
Contrast media injection to left coronary artery makes visible connections with distal part of RCA through septal vessels
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Because of the favorable anatomy of the anatomical connection between the septal branches and the distal RCA segment (Figure 4) it was decided to immediately switch to a retrograde method of RCA recanalization.
Coronary guidewire Asahi Fielder XT 300 performed by retrograde method through occlusion. Also visible is the Corsair microcatheter entered into RCA
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The guidewire and subsequently also the Corsair microcatheter were introduced into the guiding catheter (Figure 5).
Inflation of drug-eluting stent Resolute Endeavour
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Optimal effect of right coronary artery PCI with DES implantation
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TIMI 3 flow) (Figure 7). The procedure lasted 85 min, the radiation dose was 2.54 Gy, the exposure time was 34.5 min, and 550 ml of the Ultravist 370 contrast agent (Bayer, Germany) was administered.