“Scattergun” Right Coronary Artery: Heavy Calcifications in Chronic Total Occlusion Percutaneous Coronary Intervention: A Case Study

Coronary calcifications reduce procedural success rates, increase the risk of complications, and worsen the outcomes of percutaneous coronary intervention (PCI). We report the case of a 74-year-old woman with multiple comorbidities who was admitted for chronic total occlusion (CTO) PCI of the right coronary artery (RCA). Coronary angiography revealed double CTO with severe calcifications and high anatomical complexity. After unsuccessful true lumen-to-true lumen crossing, an antegrade dissection and re-entry (ADR) strategy was successfully employed. Post-procedure angiography revealed an unusual "scattergun" appearance of the proximal RCA, a parallel extra-plaque lumen with implanted stents and an occluded true lumen, separated by calcified plaque. Clinical and angiographic outcomes remained favorable at 6-month follow-up.