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%.