Coronary angiogram showed chronic total occlusion (CTO) at the proximal parts of LAD and let circumflex artery (Figure 1). All of the graft vessels were patent. However, new narrowing was seen at the distal native segment of LAD (Figure 2, Figure 3-arrow). Because the LIMA was too tortuous to be stented, we decided to correct the de novo CTO of LAD.

A 6F XB3.5 left catheter was used to engage in left coronary artery. A 0.014F Choice PT guide wire was introduced to cross the proximal LAD lesion, however it failed to passage the total occlusion. Then, a 0.014F PILOT 50 of hydrocoat hydrophilic guide wire with an OTW balloon was tried to cross the lesion (Figure 4). Fortunately, the PILOT guidewire was successfully passed the lesion without serious difficulty. Following angiogram after predilation with a 1.5 x 20 mm Maverick OTW balloon showed a diffuse stenosis from the left main to the distal LAD (Figure 5). The lesion was treated with three overlapped Cypher stents (3.0 x 18mm, 3.0 x 33mm and 2.5 x 33 mm). Final angiogram showed a very successful result without residual stenosis (Figure 6).

We experienced that the HI-TORQUE PILOT™ guide wires coated with hydrophilic polymer are very useful for complex lesion interventions by giving a smooth, effortless feel with superb torque transmission and variable tip stiffness.