1st Operator: Toshiya Muramatsu / 2nd Operator: Yoon Seok Koh

A 62 year-old male admitted for effort chest pain. He underwent coronary angiogram in another hospital, which showed chronic total occlusion of RCA. He was referred to Asan Medical Center for PCI for CTO. His coronary risk factor was hyperlipidemia.
CAG showed triple vessel disease with LM bifurcation disease. First PCI was performed for LM bifurcation lesion 1 month ago.

• Previous MI: N

• Previous CABG : N

• Previous PCI: Y

• Other: None

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

• Smoking: N
• Family History: Y (mother: sudden death)

• Age: 62
• Sex: Male

Stable angina

Echocardiography

Normal Echocardiography

Treadmill test

Negative

Thallium SPECT

Reversible large sized mildly decreased perfusion in mid to basal inferior, and basal inferoseptal walls

• The left coronary angiogram showed moderate stenosis at LM bifurcation and proximal to mid LAD. PCI was performed with 3 DES at LM bifurcation and proximal to mid LAD.
• The right coronary angiogram showed chronic total occlusion at proximal RCA. (SYNTAX score 13)

Target Lesion(s)

Proximal RCA

• ASA: Y
• LMWH: N

• Clopidogrel: Y
• Heparin: N

• Nitrates: N
• IIb/IIIa: N

• Other: beta blocker, calcium channel antagonist, statin

• Antegrade or retrograde approach for RCA-CTO