•       A 64-year-old gentleman, a known case of diabetes, hypertension,  had IWMI (2009) followed by        Unstable angina (2019)- Diagnosed as 3VD                                                           Left main - Normal                                                           LAD(M)=90%                                                           LCX –OM1=100%                                                           RCA (p) = 50%            Underwent PCI-LAD (3.5*38,3.5*12mm DES ) and PCI-LCX (2.75*18mm DES) in 2019.Now, Angina on exertion NYHA - II X 2 year, worsening from last 1 month.The 12-lead-EKG was normal.

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   Two-dimensional echocardiography showed Normal left ventricle systolic function. Laboratory parameters were in normal range. 

Angiogram suggestive of patent stents in LAD and LCX; and dominant right coronary artery with proximal cut off along with tram track calcification. The RCA is filling distally by retrograde collaterals Rentrop III. 


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7F Femoralapproach and AL 0.75 was taken.Lesion crossed with Runthrough wire with fine cross support.Predicated with 1.5*5mm semicomplaint balloon , could not crossed and busted distally.ROTA 1.5mmburr, couldn't crossed at mid RCA, even at 200000 rpm speed, likely wire bias.ROTA 1.25mm burr crossed at 150000 rpm and after that, lesion was predilated with 2.5*15 mm semicomplaint balloon, and 2.75*15 mm non complaint balloon. Stent 2.5*38mm was deployed in distal-mid RCA at 12 atm, and proximal stent 3*32 mm was deployed in mid-proximal RCA at nominal pressure with Guidezilla support.Post stent dilation was done distally with 3*15 mm and proximally with 3.5x15mm Non-complaint balloon @ 16-18 atm. Good end result.




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