Case of the Month
Operator: Dr. Raymond Chi-yan FUNG


One or Two CTOs?

A 59 male presented with exertional chest pain. He had a background of diabetes mellitus, hypertension and hyperlipidaemia. Treadmill exercise test was positive for ischaemia. His left coronary angiogram showed his LAD terminated at the proximal anterior interventricular groove resembling a mid-LAD chronic total occlusion (CTO). Distal left main (LM), mid left circumflex (LCx) and prox LAD have 50%, 80% and 80% stenosis respectively. Mid to distal right coronary artery (RCA) was blocked with 90% stenosis at prox RCA and no collaterals supplying the distal LAD. A third coronary artery was identified originating from the anterior right coronary cusp......

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