Native RCA CTO PCI

Alkis impression on the premiere of La Forza in the MET. Check it out
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Nicely done
Consider CTO PCI of native if patient is a good candidate given high re stenosis rate of SVG

IVUS first to assess if D1 ostium is involved. If it does, then either DK or culotte, if done well, makes no difference

Very unfavorable ostial LCX for stenting. Scissoring motion of vessel is a “bench model” for restenosis. DCB from the get go without stenting once available in the US (once available)

Any approach would work in this case, subxyphoid, apical and parasternal (last one not my favorite)

Rota!!!

Sometimes you do! In Under expanded stents for example. Off label !

RHC, (consider IABP) IVUS guided PCI of LM into LAD with provisional LCX) and leave RCA CTO alone. Then TAVR

If diagonal iFR is negative then iFR LAD bridge and add ranexa if positive.If no improvement then unroof

Lower the HR, in extreme cases even adenosine push, or don’t predilate if IVUS shows no severe calcium, or hold breath, or two wire technique either in LCX or in septal, or change for supportive wire, or Szabo technique (not my favorite)

Single coronary
Occluded rca. Acute or subacute..depending upon clinical presentation
Need better filling of LCX

IVUS. R/O SCAD!!!

EF??

Possibly, but not my first, second, or third choices

One view is inadequate for making recommendations. We need to see LAD diagonal better as well as RCA. There is hint that maybe more is going on, I can see a late filling of a branch that could be a collateral… I don’t believe I am saying this: Med thx

Intracoronary nitro and if lesion is real then IVUS and stent

Transplant or LVAD

What’s the reference vessel size? That will help to decide whether OPN is needed or what you have is good enough

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