1st Operator: Paul Hsien-Li Kao / 2nd Operator: Byeong-Keuk Kim

57-year-old male patient underwent PCI (LAD and LCx) for stable angina 3 years ago. Patients had stable angina and presented syncope during treadmill test, which resulted in positive change. Revascularization of RCA-CTO was tried, but not successful 3 months ago.

• Previous MI: N

• Previous CABG : N

• Previous PCI: Y (Feb 2015)
  p-mLAD (DESyne 3.5*23, Nobori 3.0*28)
  p-dLCx (Resolute Integrity 3.0*38)

• Other: none

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

• Smoking: N
• Family History: N

• Age: 57
• Sex: Male

Stable angina
Syncope during exercise stress test
(with ST depression suggestive of ischemic change)

TTE (Jan 2018)

LVEF 53%, severe hypokinesia of inferior, inferoseptal wall at base to apex

CPX (Jan 2018)

Positive

SPECT (Feb 2016)

Reversible defect in the basal inferoseptal and inferior wall

Total occlusion of dRCA (TIMI 0)
Collateral flow from septal to PD, dLCx to PL
Patent previous stents at LAD and LCx

Target Lesion(s)

CTO at dRCA
mRCA

• ASA: Y
• LMWH: N

• Clopidogrel: Y
• Heparin: N

• Nitrates: N
• IIb/IIIa: N

• Other: rosuvastatin 10 mg + ezetimibe 10 mg, carvedilol SR 8 mg, trimetazidine MR 35 mg, nicorandil 5 mg bid, diltiazem 30 mg bid

mRCA, noncalcified plaques, severe stenosis (>70%).
dRCA, noncalcified plaques, total occlusion (longer than 2cm).