Dec 10th 2020

My Wire Will Cross But Nothing Else—What Now?​

60-year-old male, complex CAD, limiting symptoms despite optimal medical therapy. Diagnostic angiogram showed degenerating graft to RCA in setting of dominant RCA CTO. Access with bifemoral 8 french guides, dual angiography showed a relatively short CTO in a heavily calcified lesion. Plan was for anterograde wire escalation and PILOT 200 wire which was able to cross the proximal and distal caps of the lesion and into the true lumen distally. Unfortunately, the micro-catheter would not go across the lesion. What to do next?