Background: IMS & SUM Hospital reports the successful revascularization of a long-segment chronic total occlusion (CTO) of the left anterior descending artery (LAD) in a high-risk patient. The procedure was performed on 28 November 2025 at the Department of Cardiology.
Case Presentation: A 45-year-old male presented with inferior wall myocardial infarction and complete heart block. The patient initially underwent primary PCI to the right coronary artery (RCA). Subsequent angiography revealed 100% occlusion of both the LAD and LCX, warranting a complex CTO procedure. The staged intervention was performed under the care of Dr. Gyana Ranjan Nayak, Interventional Cardiologist, with support from the cardiology team.
Conclusion: This case represents the successful revascularization of a technically challenging LAD CTO without complications.
Keywords: LAD CTO, antegrade wire escalation, PCI, IMS & SUM Hospital
Introduction
The Department of Cardiology at IMS and SUM Hospital successfully performed revascularization of a long-segment LAD CTO in a 45-year-old male who presented with inferior wall myocardial infarction and complete heart block.
Case Presentation
Angiographic Findings
- 100% occlusion of LAD
- 100% occlusion of LCX
- Long-segment CTO involving areas close to diagonal and septal branches
(No other diagnostic data were provided.)
Therapeutic Intervention
Procedure Overview
The LAD CTO presented significant challenges due to its long-segment morphology and proximity to diagonal and septal branches.
Dr. Gyana Ranjan Nayak utilized an antegrade wire escalation strategy using:
- Gaia 3
- Miracle 6
- Conquest Pro 12
After successfully crossing the occlusion, the intervention was completed by de-escalating to a workhorse wire.
Outcome
The procedure resulted in successful LAD revascularization with:
- No complications
- No side-branch occlusion
The post-procedural angiographic result was satisfactory, and the patient stabilized following the intervention.
Clinical Perspective
“CTO PCI continues to be one of the most demanding areas of interventional cardiology. Case selection, anticipating complications, and preparedness with bailout strategies are crucial,” said Dr. Gyana Ranjan Nayak, reflecting on the technical aspects of the case.
Acknowledgment
The hospital acknowledged the coordinated efforts of senior colleagues, residents, and support staff. Dr. Nayak also recognized the contributions of Dr. Okamura, whose work on angiographic 3D wiring has helped shape contemporary CTO strategies.
About IMS & SUM Hospital
IMS & SUM Hospital is a tertiary care medical institution in Bhubaneswar, Odisha, offering multidisciplinary clinical care, including advanced interventional cardiology services.
References
- Brilakis ES, Mashayekhi K, Tsuchikane E, et al. Guiding Principles for Chronic Total Occlusion Percutaneous Coronary Intervention. JACC Cardiovascular Interventions. 2019.
https://www.jacc.org/doi/10.1016/j.jcin.2019.02.013 - Harding SA, Wu EB, Lo S, et al. A new algorithm for crossing chronic total occlusions from the Asia Pacific CTO Club. EuroIntervention.
https://eurointervention.pcronline.com/article/a-new-algorithm-for-crossing-chronic-total-occlusions-from-the-asia-pacific-cto-club - Michael S. Lee, et al. Chronic Total Occlusion: A Review of Techniques and the Evidence Base. Circulation.
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.115.016157 - Tsuchikane E, Katoh O, et al. The Hybrid Algorithm for CTO PCI. EuroIntervention.
https://eurointervention.pcronline.com/article/hybrid-percutaneous-coronary-intervention-approach-for-chronic-total-occlusions - Okamura A, et al. CTO 3D Wiring Using Dynamic Angiography. EuroIntervention.
https://eurointervention.pcronline.com/article/three-dimensional-angiography-based-wiring-technique-in-cto - Sapontis J, et al. Outcomes, complications, and success predictors in contemporary CTO PCI (OPEN-CTO Registry). JACC Interv.
https://www.jacc.org/doi/10.1016/j.jcin.2017.03.008 - Granada JF, et al. Antegrade vs Retrograde CTO Strategies: Procedural Insights. JACC Cardiovascular Interventions.
https://www.jacc.org/doi/10.1016/j.jcin.2015.07.015 - Karmpaliotis D, et al. Advanced CTO Techniques and Outcomes in High-Volume Centers. Circulation: Cardiovascular Interventions.
https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.112.000174 - Thompson CA, et al. Retrograde Techniques in CTO Intervention. NCBI Bookshelf.
https://www.ncbi.nlm.nih.gov/books/NBK539773/ - Christofferson RD, et al. Prevalence and Clinical Outcomes of CTO in Patients Undergoing Coronary Angiography. Circulation.
https://www.ahajournals.org/doi/10.1161/01.CIR.0000127572.10446.7E
Correspondence
Correspondence:
Dr. Gyana Ranjan Nayak
Phone: 6371307504
