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Chronic Total Occlusion, Treated by Cypher Stent
- Operator : Myeong-Ki Hong, MD
Case Presentation
The patient was 57 year-old male. He presented with a effort chest pain for 1 year. He had a hypertension as a coronary risk factor. Echocardiography showed normal LV ejection fraction of 56% without regional wall motion abnormality.
Baseline coronary angiography
1. Right coronary angiogram showed total occlusion with TIMI 1 flow at distal RCA (Figure 1, Figure 2).

2. Left coronary angiogram showed normal LAD and LCX, and good collateral flow to distal RCA (Figure 3).

Procedure
A 7F sheath was inserted through right femoral artery and the right coronary was engaged with a 7F JR catheter. A 0.014² Choice PT guidewire with a 2.0 x 20 mm Maverick OTW balloon was advanced easily into the distal part of the occluded lesion (Figure 4). After changing to Floppy guidewire, predilatation was performed with the same OTW balloon (Figure 5). However, distal RCA remained narrowed (Figure 6). Thus a 3.0 x 18 mm Cypher stent was implanted in distal RCA lesion (Figure 7). Unfortunately, the proximal part of the Cypher stent looked to be narrowed by angiogram (Figure 8). And IVUS image at the proximal part of the Cypher stent showed stent inapposition at 1 O’clock due to undersized stent (Figure 9). Until now, stents in diameter > 3.0 mm are not available in Korea. Therefore an additional 4.0 x 8 mm Bx stent was implanted for complete coverage of the proximal narrowed lesion, while overlapping with the Cypher stent (Figure 10). Final angiogram showed good result of procedure (Figure 11).
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