Case and Plan:

47-year-old male presented with unstable Class III angina and positive stress MPI test. A Cardiac Cath on October 15, 2024 at OSH revealed 2V CAD: ostial LAD CTO (J-CTO score 4), 80% – 90% calcified LCx lesions, syntax Score of 23 and normal LV function. Patient underwent successful PCI of proximal LCx and OM2 using Rota DES x 2. Subsequently patient had stress MPI revealing residual severe anterior wall ischemia and fall in EF from 63% to 55% post stress. After Heart Team discussion, CABG was recommended, but declined by the patient. Patient is now planned for complex PCI of LAD CTO via retrograde approach due to ambiguous ostial LAD cap.

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