CASE & Plan:
67-year-old male with CCS Class III angina and prior CABG & PCI’s. A Cardiac Cath on May 2, 2023 revealed 3 V CAD: distal RCA CTO with distal vessel fills via SVG, multiple 80% calcified LAD lesions with DES ISR in distal LAD, LAD-D2 CTO with ISR, proximal LCx CTO, patent LIMA to LAD with distal LAD ISR and patents SVG to RPDA with 80-90% lesions in retrograde limb supplying 80% RPL and CTO LCx. Patient underwent successful PCI of distal LAD via LIMA using PTCA and Atherotomy. Patient is now planned for staged complex PCI of SVG-RPDA retrograde limb and/or LCx CTO.