PMC8416397_01
(a) Coronary angiogram of the LCA showing a severe bifurcation lesion involving the proximal LAD and LCX. (b) RCA angiogram shows a proximal CTO with a diffusely calcified vessel. There is a broken guide wire tip in the mid portion of the RCA from the previously failed PCI attempt.
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fig1
The proximal left anterior descending (LAD) and left circumflex (LCX) arteries showed 99% stenosis, and the right coronary artery (RCA) was totally occluded (Figure 1).
(a) Rotational atherectomy through the vessel architecture of the proximal segment of the RCA CTO lesion. (b) Guide extension catheter (Guidezilla) placed through antegrade guiding catheter helps with tracking the retrograde guide wire into the antegrade guiding catheter.
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fig2
RotaWire (Boston Scientific, Marlborough, MA, USA) through the architecture of the occluded vessel followed by rotational atherectomy with a small-sized (1.25 mm) burr. Repeated cycles of proximal cap modification with further advancement of the RotaWire and rotational atherectomy through the vessel architecture facilitated passage of the antegrade gear (microcatheter and guide extension catheter) through the long CTO segment (Figure 2).
(a) Successful wiring of RCA into PD and PL blanches. PD = posterior descending; PL = posterolateral. (b) RCA angiogram postprocedure. (c) Left angiogram postprocedure.
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fig3
Three DES were implanted into the RCA with satisfactory final results (Figure 3).