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Case 235: Manual of CTO PCI - Easy CTO?

A patient was referred for PCI of a LAD CTO due to angina. The CTO was short (~5 mm) with blunt proximal cap and diffusely diseased distal vessel and was filling via both septal and epicardial collaterals from the RCA. Antegrade crossing attempts failed. Retrograde crossing of a septal branch was successful using a Suoh 03 wire, but the wire entered the diagonal branch. Repeat antegrade crossing attempts with a Gaia Next 2 wire resulted in extraplaque crossing. Parallel wiring failed as did Stingray re-entry. The Stingray balloon was advanced more distally in the LAD and re-entry was achieved using the “stick and drive” technique with an Astato 20 wire. Using a Sasuke dual lumen microcatheter a wire was advanced into the diagonal branch, followed by successful stenting of the LAD.