1st Operator: Yasumi Igarashi / 2nd Operator: Hoyoun Won

45-year-old male patient underwent direct PCI (RCA) for STEMI (inferior) 2 years ago. Also, there was LAD CTO lesion, 4 days later, 2nd stage LAD CTO intervention was tried with antegrade approach but failed.

• Previous MI: Y

• Previous CABG : N

• Previous PCI: Y (July 2017)
  s/p PCI at RCA(ultimaster 3.5x24)

• Other: HTN, dyslipidemia

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

• Smoking: N
• Family History: N

• Age: 45
• Sex: Male

Stable angina [select one]
Exercise stress test positive result at stage IV
(with ST depression suggestive of ischemic change)

Echocardiography

RWMA at RCA and LAD territory, EF=42%

Treadmill test

Stage IV positive with ST depression

Total occlusion of mLAD (TIMI 0)
Collateral flow from PD to dLAD, OM to dLAD (G2)
Patent previous stents at mRCA

Target Lesion(s)

CTO at mLAD

• ASA: Y
• LMWH: Y

• Clopidogrel: Y
• Heparin: N

• Nitrates: Y
• IIb/IIIa: N

• Other: bisoprolol 1.25mg QD, Ezetimibe 10mg QD, Rosuvastatin 20mg QD

pLAD, noncalcified plaques, severe stenosis (>70%).
mLAD, total occlusion

Stent : Ultimaster 3.5x24 at mRCA