A 67 years old was admitted for several months of effort angina. His coronary risk factors were diabetes, hyperlipidemia and hypertension.Electrocardiography showed T- wave inversion in V4-6 and X-rays was normal.
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Initial laboratory findings were unremarkable. Echocardiography showed normal left ventricular systolic function (EF=60%) without regional wall motion abnormality.
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Relevant Catheterization Findings: The target lesion was a CTO lesion in the proximal LAD.The distal LAD was well filled with the  rich collateral channels of the RCA
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A 6 Fr EBU 3.75 guilding  catheter was engaged in the left coronary artery. First, the antegrade approach was tried system 0f 0.014" Fielder XT a with 180cm 2.0x 15mm Maverick over-the-wire (OTW) balloon. and  then guildewire was changed to Gaia second with supporting with microchatheter, the guildewire pastthrough the CTO lesion and running to the distal of  left  anterior descending coronary artery. Tip injection showed the wire in real cavity of LAD. Second, predialated with Firefight 1.0-15mm, 2.0-20mm balloon respectively. Lastly  A 2.5x30 Resolute ONYX stent was deployed into the  proximal of LAD.
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We use antegrade approach to open the proximal of left anterior descending coronary artery CTO lesion. the angiogram showed successful recanalization of left anterior descending coronary artery CTO lesion