A 59 years old female patient (K/C/O- T2DM/HTN/CAD/OLD AWMI) presented here with C/o Exertional heaviness in chest, breathlessness for last 2-3 years, symptoms increased for last 2-3 months prior to admission.

ECG shows QS pattern Right precordial leads. 2D-ECHO suggestive of CAD/RWMA- Septum & Apex are hypokinetic. Moderate LV Systolic Dysfunction (LVEF = 40%). Type II LV diastolic dysfunction. Mild MR, Mild TR, No PAH.

Left Main: Normal. LAD: Ostial CTO, distal vessel filling through collaterals. LCX: Non-dominant, Normal. OM1&OM2: Normal. RCA: Dominant, mid minimal disease. PDA/PLV: Normal. Advised PTCA TO LAD after viability assessment if viable territory.Stress Thallium Test: Features on spect myocardial perfusion scintigraphic study are consistent with myocardial infraction involving apical and septal/anteorseptal walls with peri-infarct ischaemia specially at septal wall. Plan PTCA to LAD.
KISHWAR JHAN CAG.wmv

PTCA TO LAD: Left Coronary Artery was engaged with EBU 3.0 x 6F guide catheter. A 0.014” SION BLUE with Microcatheter, then another PTCA wire PILOT-50 was used to cross the LAD lesion. After that another regular PTCA wire SION BLUE park the distal LAD. Pre dilatation done with SC Sapphire Balloon 2.0 x 10 mm @ 12 atmosphere. Drug Eluting Stent RESOLUTE ONYX 3.5 x 30 mm deployed in LAD @ 16 atmosphere. Post dilatation done with NC Sapphire Balloon 3.5 x 10 mm @ 16 atmosphere. GP IIb IIIa inhibitor was used during the procedure. Excellent result with TIMI III flow. Successful PTCA with stenting to LAD.
KISHWAR JHAN (PTCA).wmv

Advances in equipment and technique have undoubtedly led to improvements in the field of CTO PCI. Antegrade approach remains the predominant strategy for crossing short CTOs of lower complexity. However, many CTOs can only be opened with a dissection-based strategy, and ADR offers a safe and efficient means to achieve this when used in appropriately selected cases.