The LAD had a high-graded proximal stenosis, but was supplied by a patent LIMA graft with good distal run-off. However, retrograde filling from septal collateral connections (CC) of the left coronary artery (LCA) was evident clearly ( Figure 1). The right coronary artery (RCA) revealed a chronic total occlusion (CTO) initiating from the RCA ostium already. In 2008 renal re-transplant was performed and finally lead to a constant improvement of GFR to 56 mL/min/m 2.Įmergency coronary angiography showed diffuse coronary artery disease (CAD) with severe calcifications of all native coronary arteries. Afterwards the patient required regular renal replacement therapy and parathyroidectomy to avoid ongoing secondary hyperparathyroidism. Additionally, past medical history consisted of end-stage renal failure due to glomerulonephritis, renal transplantation in 1999 and subsequent transplant failure in 2005. Coronary bypasses consisted of a left internal mammarian artery (LIMA) graft to the left anterior descending (LAD) coronary artery, a saphenous vein graft (SVG) to the obtuse marginal (OM) branch and a SVG to a diagonal branch. Already in 2006 the patient received coronary artery bypass graft (CABG) surgery due to a coronary multi-vessel disease while exerting typical angina pectoris at low exercise levels according to Canadian Cardiovascular Society (CCS) class III. The patient’s medical history revealed an increased cardiovascular risk profile including the presence of arterial hypertension and dyslipidemia. Accepted for publication Sep 12, 2016.Ī 49 years old man presented with a non-ST-segment elevation myocardial infarction (NSTEMI) in March 2014. Keywords: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) subintimal last option Interviews with Outstanding Guest Editors.Policy of Dealing with Allegations of Research Misconduct.Policy of Screening for Plagiarism Process.
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