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  • CTO – Is It Worth the Effort?

    This morning at report, a case was presented that captured the evolution of interventional cardiology. We had attempted angioplasty of a patient's chronically occluded left anterior descending (LAD) artery in 1985 but failed, and he continued with medical therapy for the next 35 years. Now he presents with angina and was reinvestigated in the cath lab. His LAD was still occluded, and there were 90% stenoses in the two large circumflex marginal branches and the right coronary artery. The SYNTAX score was 33. He was agreeable to proceeding with percutaneous coronary intervention (PCI), and the circumflex lesions were stented successfully. Next, the long right coronary lesion was stented. Then the chronic total occlusion (CTO) of the LAD was attempted. The wire traveled subintimally, but with the Stingray system, the true lumen was re-entered and the LAD was stented. Intravascular ultrasound confirmed proper apposition of the stent and adequate lumen dimensions. The procedure was completed in 2 h, and the angiographic result was spectacular.

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