Although the antegrade dissection and re-entry technique (ADR) with Stingray system is one of the procedures for percutaneous coronary intervention (PCI) of chronic total occlusion (CTO), it has some risk of side-branch occlusion. This article reports a CTO case in the left circumflex artery successfully treated with combination use of ADR subintimal tracking and intravascular ultrasound (IVUS)-guided re-wiring without side-branch occlusion. Antegrade approach with single-wire and parallel-wire technique was failed. Retrograde approach through ipsilateral collateral was also failed. Therefore, the ADR was attempted and Stingray wire crossed through at the distal site of posterolateral (PL) branch. To avoid PL branch occlusion, IVUS-guided re-wiring to the true lumen was attempted. Finally, the CTO lesion was recanalized without any complication and 1 year follow-up angiography had good result. ADR as preparation of IVUS-guided re-wiring might be one of the useful procedures for those complex CTO cases.
Keywords: Chronic total occlusion; Complications; Hybrid revascularization; Intravascular ultrasound.