Case 109: Manual of CTO Interventions - LAD CTO with bifurcation at the proximal cap

Patient presented with an LAD CTO due to in-stent restenosis immediately after the takeoff of a very large (also previously stented) diagonal branch. Antegrade wire escalation failed. Retrograde crossing was successful via a septal collateral, followed by true-to-true crossing as confirmed by IVUS into an angrade Guideliner. After externalization and predilation, an antegrade wire was advanced to the LAD, followed by stenting of LAD/Diagonal using the DK crush technique.