1st Operator: Nae Hee Lee / 2nd Operator: Jon Suh

A 66-year old male admitted for dyspnea on exertion started from 2 months ago. He had a previous history of failed PCI at mid LAD CTO lesions 12 years ago. After then, he have not visited the out-patient clinic.
His coronary risk factors were diabetes, hypertension, and ex-smoker.

• Previous MI: N

• Previous CABG : N

• Previous PCI: N (failed)

• Other: permanent pacemaker implantation due to sick sinus syndrome (5 years ago)
  history of cerebrovascular accident (6 years ago)
  Nonvalvular atrial fibrillation on dabigatran

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

• Smoking: Y (quit 20 years ago)
• Family History: -

• Age: 66
• Sex: Male

Stable angina

Echocardiography

Akinesia of apical septum and inferior walls with mild LV dysfunction (LV EF 46%)

Treadmill test

Not done

Thallium SPECT

partially reversible large sized absent perfusion in apical to mid anterior and apical septal walls

• The left coronary angiogram showed chronic total occlusion of proximal to mid LAD.
• The right coronary angiogram showed mild CAD. (SYNTAX score 26.5)

Target Lesion(s)

Proximal to mid LAD

• ASA: Y
• LMWH: N

• Clopidogrel: N
• Heparin: N

• Nitrates: N
• IIb/IIIa: N

• Other: calcium channel antagonist, angiotensin receptor blocker, amiodarone, dabigatran, statin

• Antegrade approach (+/- IVUS-Guided Penetration technique)