Percutaneous Coronary Intervention for Chronic Total Occlusion in a Patient with Situs Inversus: Challenges and Technical Considerations

Situs inversus is a rare condition that makes interventional procedures more challenging. We present a case of situs inversus associated with right coronary artery occlusion that was first documented on Coronary CT Angiography. The procedure required multiple catheter exchanges and the use of a guide-extension catheter, ultimately resulting in successful stent implantation. CTO PCI in situs inversus requires special considerations due to the reversed coronary anatomy. Standard interventional techniques may not always be effective, requiring adjustments in catheter and wire selection, fluoroscopic views, and support strategies. A stepwise approach, incorporating appropriate catheter support and thorough lesion preparation, is key to achieving successful outcomes.