1st Operator: Seung-Whan Lee / 2nd Operator: Chang Hoon Lee / 3rd Operator: Gyung-Min Park

A 76 year-old female admitted for intermittent chest pain during hemodialysis. She had a previous history of PCI with DES at proximal to distal LCX and distal RCA to PDA 5 years ago. And she underwent PCI with DES for mid LAD lesion 2 months ago. Her conventional coronary risk factors were diabetes, hypertension, and dyslipidemia.

• Previous MI: N

• Previous CABG : N

• Previous PCI: Y / ERSD on HD

• Other: History of VF arrest due to hyperkalemia
  PAOD at Rt. CFA, s/p percutaneous transluminal angioplasty (‘13)

• Diabetes: Y
• Hypertension: Y
• Hyperlipidemia: Y

• Smoking: N
• Family History: N

• Age: 76
• Sex: Female

Stable angina

Echocardiography

Akinesia of basal inferior wall with near normal LV systolic function, Moderate to severe functional MR

Treadmill test

Not done

Thallium SPECT

Reversible large sized moderately decreased perfusion in basal inferoseptal and mid-basal inferior wall

• The left coronary angiogram showed tight mid LAD lesion (PCI was done) and patent previous stent at proximal to distal LCX. And the collateral flow from septal branches to PDA was observed.
• The right coronary angiogram showed chronic total occlusion of mid RCA. (SYNTAX score 16)

Target Lesion(s)

mRCA CTO

• ASA: Y
• LMWH: N

• Clopidogrel: Y
• Heparin: N

• Nitrates: N
• IIb/IIIa: N

• Other: beta blocker, calcium channel antagonist, angiotensin receptor blocker, statin

• Anterograde or retrograde approach of total occlusion of RCA