1st Operator: Yasushi Asakura / 2nd Operator: Hyuck Jun Yoon

A 61 year-old male admitted for dyspnea on exertion aggravated from 1 month ago and ECG abnormalities (Q in inferior leads).
His coronary risk factors were hyperlipidemia and ex-smoker.

• Previous MI: N

• Previous CABG : N

• Previous PCI: N

• Other: None

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

• Smoking: Y (quit 10 months ago)
• Family History: N

• Age: 61
• Sex: Male

Stable angina

Echocardiography

Akinesia of inferoposterior walls with mild LV dysfunction (LV EF 51%)

Treadmill test

Not done

Thallium SPECT

Partially reversible large sized severely decreased perfusion in mid to basal inferoseptal, inferior walls

• The left coronary angiogram showed normal findings and epicardial collateral flows from LA branch and LCX to PL branch, and from septal branches to PDA.
• The right coronary angiogram showed chronic total occlusion at proximal RCA. (SYNTAX score 16)

Target Lesion(s)

Proximal RCA

• ASA: Y
• LMWH: N

• Clopidogrel: Y
• Heparin: N

• Nitrates: N
• IIb/IIIa: N

• Other: beta blocker, calcium channel antagonist, angiotensin receptor blocker, statin

• Antegrade or retrograde approach for RCA CTO