Ask Dr. Z

I have a case in which a patient has a subtotally occluded RCA in the mid segment then proceeds to chronic total occlusion in the mid segment. PCI was performed as follows. "A 0.014 inch Asahi Prowater wire was used to attempt to cross the totally occluded segment of the right coronary artery although we were unsuccessful. After this, a 1.5 x 8 mm over the wire Emerge balloon was then used in attempts to exchange the Prowater wire for a hydrophilic wire. We had difficulty passing the Emerge balloon through the stenosed segment in the proximal right coronary artery. PTCA was then performed to the proximal right coronary artery with the 1.5 x 8 mm Emerge balloon at 8 to 10 atmospheres. This was repeated x2. We were still unable to advance the balloon any further. We exchanged the 0.014 inch Asahi Prowater wire for a 0.014 inch Whisper wire; however, we were still unsuccessful in being able to cross the occluded right coronary artery segment. At this point, we decided to abandon the procedure." I am not sure whether to use the 92943 for the CTO or the 92920. Since it appears he treated the subtotal segment I lean toward 92920 even though he was trying to treat the CTO. Thank you for your help.