Jeffrey M. Chua, MD

Jeffrey M. Chua, MD ❤️ Healthy Heart. High success rates. Patient-focused.

Healthy Life
Your heart deserves the best care — & latest treatments

Specialist in:
✔️ Advanced Angioplasty
✔️ Complex PCI & CTO Procedures
✔️ Intravascular Imaging - IVUS, OCT

🩺 Cutting-edge care.

25/07/2026

A thrombotic occlusion with fluoroscopic evidence of underlying calcification.

The immediate question was: What was the mechanism? Was this simply a heavily calcified thrombotic plaque, or could it represent an eruptive calcified nodule—an increasingly recognized cause of ACS characterized by protruding calcium, thrombus formation, and marked device resistance?

Given the inability to cross the lesion with a balloon, rotational atherectomy was performed for plaque modification, allowing successful lesion preparation, stent delivery, and restoration of coronary flow.

A reminder that not all thrombotic occlusions are soft lesions. When thrombus coexists with severe calcification, recognizing the underlying pathology is critical, as conventional PCI techniques alone may not be sufficient.

Another lesson in the complexity of calcium.

24/07/2026

Not every successful CTO PCI ends with a perfect angiographic result. Some cases demand adapting to anatomy, overcoming unexpected challenges, and making difficult decisions every step of the way.

This CTO presented with multiple layers of complexity:
• Ambiguous, balloon-uncrossable proximal cap
• Long-segment occlusion
• Wire-uncrossable distal cap involving a bifurcation
• Episodes of hemodynamic instability during the procedure

Despite these challenges, successful recanalization was achieved through a retrograde strategy, utilizing septal collateral crossing, HDR at multiple levels, retrograde knuckle wiring, and extensive troubleshooting during extended reverse CART.

Perhaps not a textbook-perfect angiographic result, but a successful procedure nonetheless—restoring flow while balancing technical success with patient safety.

Grateful for the trust of the referring physician and for the opportunity to manage such a demanding case.

24/05/2026

Case presented in EuroPCR 2026
“Case-based challenges and dilemmas in multivessel PCI”

High-risk NSTEMI. Severe multivessel disease. CTO. Complex LM bifurcation. Heavy calcification.

CABG was recommended. The patient declined.

So we leaned into what we do best.
Planned. Imaged. Executed.

CTO PCI techniques. Calcium modification with atherectomy. 2-stent bifurcation PCI techniques. Imaging-guided PCI.

Complex PCI: once considered high risk, limited… has evolved. Today, in the right setting, it offers a viable, effective path to revascularization.

15/05/2026

Sometimes, the most challenging CTO PCI cases demand more than routine algorithms and standard techniques.

This complex case involved:
• Challenging CTO anatomy
• Complex LM bifurcation disease
• Severe coronary calcification
• High technical difficulty in CTO wire crossing and wire externalization

Successful revascularization was ultimately achieved through a combination of:
• Retrograde CTO strategy
• Intracoronary snaring of the retrograde wire using a home-made snare within the LCX artery
• Complex LM bifurcation PCI
• Orbital atherectomy for heavily calcified plaque modification

In complex CTO and CHIP interventions, creativity, adaptability, and mastery of advanced bailout techniques often become the difference between failure and success.

13/05/2026

Not every short CTO is a simple CTO.

This blunt proximal cap CTO challenged us at every step:
• Failed antegrade IVUS-guided wiring
• Failed retrograde epicardial collateral microcatheter tracking
• Failed antegrade marker wiring
• Failed initial rendezvous / tip-in attempts

Persistence, strategy modification, and meticulous technique eventually turned the case around — with improved guide support, enhanced microcatheter penetrability, and retrograde wire escalation leading to successful CTO recanalization.

Complex CTO PCI is often a battle of adaptation, patience, and knowing when to change the strategy.

12/05/2026

Not every ACS NSTEMI case is straightforward. Some demand more than just urgent revascularization. They require the right strategy.

This complex case involved:
• Multivessel coronary artery disease
• Heavily calcified Left Main to LAD disease
• CTO of the RCA
• High ischemic risk with equally high procedural complexity

In cases like this, success is not simply about “opening the artery.” The real challenge is deciding:

• When is the optimal timing for PCI?
• Which vessel should be treated first?
• Culprit-only vs staged complete revascularization?
• Should the CTO be addressed immediately or deferred?
• What is the safest and most effective calcium modification strategy?

Complex ACS PCI is where timing, hemodynamic assessment, imaging, device selection, and operator strategy all converge. Every decision and step changes outcomes.

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