PLENARY SESSION Wrap up of live cases, awards to the winners of the best abstracts and case competitions and take home messages Auditorium Zubin Mehta - Saturday 16:00 - 17:00 Speakers: Daniela Benedetto (Rome), Francesco Burzotta (Rome), Carlo Di Mario (Florence), Roberto Garbo (Turin), Rocco Stio (Rome) Challengers: Stelios Pyxaras (Furth - D), Sudhir Rathore (London - UK) Discussants: Shunsuke Matsuno (Tokyo - J), Alexander Nap (Amsterdam - NL), Masahisa Yamane (Tokyo - J) ___________________________________________ 15th Experts Live CTO, EUROCTO Club meeting in partnership with the GISE CTO meeting. September 8th - 9th, 2023 Florence, Italy

1. Case #1
FONDAZIONE POLICLINICO «A. GEMELLI» IRCCS
ROME, ITALY

2. Male, 60 years old H: 176 cm W: 80 kg
Risk Factors
-Diabetes mellitus (oral therapy)
-Hypertension
-Dyslipidemia
-Previous smoking habit
Case#1 Presentation (Mr. M.B.)
Previous medical history
- 2009 diagnosis of non Hodgkin lymphoma of the small intestine
- 2017 liver transplantation for HCV-related liver cirrhosis
Clinical presentation
- Effort angina since late 2022
- March 2023 admitted for abdominal pain: EKG possible recent antero-apical myocardial infarction -> cardiac work-out

3. EKG on admission

4. Echocardiogram
Normal global contractility (minor hypokinesia in
apical-septal segment)

5. Coronary Angiography (March 2023)
Proximal RCA critical stenosis and postero-
lateral branch subocclusion.
Proximal LAD chronic total occlusion,
partially rehabilitated by homocoronary
collateral circulation (Rentrop 3, J-CTO score
2).
Critical stenosis of circumflex artery and first
marginal branch.

6. Percutaneous Coronary Intervention
(March 2023)
Unsuccessful attempt of antegrade PCI on
proximal LAD.
PCI with 3 DES in overlap on circumflex artery and
first marginal branch.
PCI with DES on RCA, posterolateral branch and
posterior interventricular artery.

7. Clinical course
The patient was discharged with a recommendation for myocardial stress scintigraphy to assess
myocardial viability and ischemia in the LAD perfusion territory.
Patient still symptomatic for effort angina (started to be complained since return to normal life)
including one more severe episode forcing for hospital admission on July 2023
-> Positive Troponins (without rise and fall), no EKG or echocardiographic changes
-> Repeated Coronary angiography

8. Coronary Angiography (July 2023)
Coronary angiography showed patency of previously implanted stents on RCA and circumflex artery

9. Confirmed CTO of proximal LAD

10. Confirmed CTO of proximal LAD

11. Cardiac Magnetic Resonance
NO SCAR (<50% subendocardial LGE of the apical septum and mid-ventricular antero-lateral walls)

12. The final result

13. The key for the success

14. The key for the success

15. The key for the success

16. The key for the success

17. The key for the success

18. Case #2
FONDAZIONE POLICLINICO «A. GEMELLI» IRCCS
ROME, ITALY

19. Male, 44 years old H: 180 cm W: 80 kg
Risk Factors
Clinical Presentation
- Hypertension
- Active smoker (50 sig. per day)
Case #2 Presentation (Mr D.D.E.)
- March 2023: admitted for inferolateral STEMI → primary PCI with DES of mid-Cx (+ evidence of RCA CTO)
- Dyslipidemia
- Family history of early myocardial infarction

20. Urgent coronary angiography (Trans-radial access)

21. Urgent coronary angiography (Trans-radial access)

22. Urgent coronary angiography

23. Primary PCI on LCX

24. ‘Gentle’ (non-CTO wires) attempt on RCA

25. One CTO or two sequential CTOs?
Where is the
proximal cap ?

26. Pre-discharge EKG

27. Pre-discharge Echo

28. Cardiac Magnetic Resonance
NO SCAR

29. Coronary CT

30. Coronary CT

31. The final result

32. The key for the success

33. The key for the success

34. The key for the success

35. The key for the success
Contrast dose 145 ml !!!