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Updated: May 26, 2026

Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
Published on: April 17, 2021
CT coronary angiography-guided percutaneous coronary intervention for chronic total occlusion combined with
Hideyuki Takimura1, Toshiya Muramatsu, Reiko Tsukahara
1Division of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumiku, Yokohamashi, Kanagawaken, Japan. h_takimura@tobu.saiseikai.or.jp
Insights
This study details a challenging percutaneous coronary intervention for a right coronary artery chronic total occlusion. Advanced techniques, including CT coronary angiography, were crucial for successful stent deployment in a complex case.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Imaging
Background:
- Chronic total occlusion (CTO) of the right coronary artery (RCA) presents significant challenges for percutaneous coronary intervention (PCI).
- Previous stent implantation at the RCA ostium can complicate antegrade guidewire access to the CTO true lumen.
- Complex CTOs often require advanced imaging and multi-approach strategies for successful revascularization.
Abstract:
Percutaneous coronary intervention was performed for chronic total occlusion (CTO) of the right coronary artery (RCA) in a 55-year-old man. CT coronary angiography (CTCA) with a 64-slice scanner showed a large calcified plaque at the entrance to the CTO. A stent that had been implanted at the RCA ostium 10 years earlier was angled toward a side branch, suggesting that the guidewire would not reach the true lumen via the antegrade approach. Therefore, we attempted the retrograde approach via a septal collateral with the kissing wire technique. However, the guidewire failed to cross the CTO because of obstruction by the implanted stent. We next attempted the controlled antegrade and retrograde subintimal tracking technique and 2 stents were successfully deployed. In this patient, CTCA provided useful information for management of a difficult CTO.
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