Figure 1.

Example of the usefulness of multi-modality imaging in placing a correct indication for CTO percutaneous treatment. A 72-year-old patient performed a coronary computed tomography angiography (CCTA) (A) that showed severe three-vessel disease with occlusion (yellow arrow) of the left anterior descending (LAD) coronary artery. Coronary angiography (B) confirmed the presence of a calcified lesion occluding the LAD (yellow arrow) that was filled by means of collateral circulation. In consideration of the lack of symptoms and the unfavorable anatomy, it was decided not to proceed with a procedure without first assessing ischemia in the territory of the vessel. Cardiac stress magnetic resonance (C) showed inducible ischemia and myocardial viability in the mid-apical segment of the anterior wall and the interventricular septum (yellow arrow). Coronary angioplasty was then performed with implantation of a drug-eluting stent in the left main and LAD with an excellent result (D). Vessel patency without restenosis was confirmed by coronary CCTA at follow-up (E).