A 44-year-old man was admitted to our hospital for treatment of CAD. He had a history of MI and had undergone successful stenting with Cypher for LAD lesion, but failed PCI for pRCA CTO lesion at 2006. At 2008, PCI was performed for pRCA CTO lesion but failed because of guide wire passage failure. He has a history of hypertension,dyslipidemia and smoking. Treadmill test showed negative findings and trans-thoracic echocardiography revealed focal akinesia of mid septum with normal LV systolic function (EF=62%).

1. A right coronary angiogram showed total occlusion of pRCA with collateral flow from to LAD( Movie 1).
2. A left coronary angiogram showed patent stent state at pmLAD( Movie 2).

Right coronary was cannulated with a 7 Fr AL 1 SH guiding catheter. By using 0.014inch 1.8Fr 130cm Finecross micro guide catheter, 0.014 inch Fielder XT wire was tried to pass through pRCA CTO lesion angtegradely(Figure 1, Figure 2) and passed successfully (Figure 3, Figure 4). Several sequential balloon dilatation with Maverick 2.0*20mm was performed (Figure 5, Figure 6).

After IVUS examination, We deployed #2 stent firstly Cypher select 2.75 * 33 mm and secondly Cypher select 3.0 * 18 mm.(Figure 7, Figure 8) After deploying stent, high pressure ballooning with stent balloon was done.

The final angiogram showed well positioned and expanded stent with good distal run-off flow( Movie 3).