Drug-eluting balloon angioplasty for bifurcated chronic total coronary occlusion

To the Editor, This is the case of a 67-year-old woman admitted due to a 6-month history of exertional angina. Stress echocardiography showed severe anterior wall ischemia. The patient was referred for coronary angiography that revealed the presence of a chronic total coronary occlusion of the proximal left anterior descending coronary artery (LAD) immediately before the bifurcation with the first diagonal branch (D1) from the septal collaterals of the right coronary artery (figure 1, video 1 of the supplementary data). The patient signed the written informed consent, and a chronic total coronary occlusion recanalization was performed 6 months after the index angiography. Figure 1. A: cranial view of chronic total coronary occlusion of proximal left anterior descending coronary artery (LAD). B: postoperative final angiographic result with a small non-flow limiting dissection in the mid-LAD treated conservatively. C: angiographic control at 6 months showed great outcomes using drug-eluting balloons. The distal vessel has increased its size with no signs of the small dissection whatsoever. Initial antegrade acess was planned given the lesion’s favorable characteristics (Japan-chronic total occlusion score of 1). An ultrasound-guided dual angiography was performed with a 7-Fr AL1 guiding catheter (Cordis, United States) via femoral access for the right coronary artery, and...