I tried to do an 8 fr AL with a 2 cm CTO at the RCA CTO, and easily got into the CTO at N3. I tried TDreruiting from there with IVUS guide, but could not with G4. I tried TDADR from false, but could not see it due to calcification, so I did TDADR with konfienza ST puncture to the plaque with angiofusion at the back of #2 where I could see it. However, it was difficult to puncture from the large false to the true, and once the wire was caught in the true by a piece of skin, I tried to replace it with sion black wire.
It immediately went to false. However, the MC was placed close to true, so I inserted the TIP from there toward the intima and was able to make it happen. In other words, TDADR alone was not enough to guide the wire, so I placed the MC close to the plaque, and from there, I inserted the ST to the opposite side of the IVUS, inserted the micro, and passed sion black into true lumen , then finish ed the treatment.
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