[April 25] CTO LIVE_Asan Medical Center, Seoul, Korea: Case #1

- Operator : Seung-Whan Lee

1st Operator: Seung-Whan Lee / 2nd Operator: Chang Hoon Lee / 3th Operator: Gyeong-Min Park

Brief Case Summary

A 57 year-old male was admitted for the evaluation of coronary CT angiography abnormality. The coronary angiography was performed which revealed significant stenosis at proximal to mid LAD and total occlusion at proximal RCA. Then, proximal to mid LAD lesion was stent implanted.

Past Medical History

  • Previous MI: N
  • Previous CABG : N
  • Previous PCI: Y
  • Other: h/o CVA, current smoker

Demographic Characteristics

  • Diabetes: Y
  • Hypertension: N
  • Hyperlipidemia: N
  • Smoking: Y
  • Family History: N
  • Age: 57
  • Sex: Male
  • Other: h/o CVA

Clinical Presentation

Silent ischemia

Non-invasive Studies


Akinesia of inferoposterior wall with normal LV systolic function (EF 54%)

Treadmill test


Thallium SPECT

Not done

Cardiac Catheterization Findings

  • The coronary angiography showed total occlusion at proximal RCA with grade 3 collateral flow from OM.
  • Significant stenosis of proximal to mid LAD was also shown.
  • SYNTAX score: 28

Case Notes

Target Lesion(s)

Proximal RCA

Adjunctive Medication

  • ASA: Y
  • LMWH: N
  • Clopidogrel: Y
  • Heparin: N
  • Nitrates: N
  • IIb/IIIa: N
  • Other: Beta-blocker, statin

Teaching Points

  • Anterograde or retrograde approach of total occlusion of RCA

Coronary Angiography

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