Outcome and follow-up
After a thorough evaluation of his anatomy, the patient underwent percutaneous revascularization in two settings, first, multivessel PCI with Impella CP (Abiomed, Danver, Massachusetts) support (Figure 3, A, B) of LAD and Circumflex. Furthermore, the patient subsequently underwent chronic total occlusion (CTO) PCI to achieve complete revascularization. The CTO PCI of the right coronary artery was performed via primary retrograde approach with the placement of two drug-eluting stents (Figure 3, C, D). After complete revascularization, the patient’s symptoms have improved significantly with the marked reduction in his NYHA class. Three months after, patient was NYHA Class I and his echocardiogram showed a significant recovery in LVEF to 45-50%.