Right coronary artery was engaged with a 7 Fr XB 3.5 guiding catheter and left coronary artery was positioned with a 7 Fr JR4 SH guiding catheter through the bi-femoral approach. We tried to reach the distal cap of the CTO lesion through several septal braches using Fielder FC, XT, XT-A wires with Cosair¢ç 150cm microcatheter. After several trials, we barely found the optimal septal brach (Figure 1). We tried to pass the proximal RCA-CTO lesion with a 0.014 inch Gaia 2 wire, but also failed ( Movie 3). So, we changed wire into 0.014 inch Ultimate 3 wire and successfully penetrated the proximal cap ( Movie 4). After advancement of Corsair¢ç microcatheter into the right guiding catheter, a retrograde wire was exchanged for a 0.010 inch RG3 wire. And then we performed several balloon dilatations at proximal to distal RCA using a Maverick balloon 1.5x20mm and 2.5x15mm (Figure 2). After predilatations, we deployed a three Xience Xpedition stents (3.0x38mm, 3.5x38mm, and 4.0x23mm, distal to proximal RCA, Figure 3) sequentially. The final angiogram showed successful revascularization at RCA CTO lesion ( Movie 5).
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