Recanalizing a right coronary artery chronic total occlusion with J chronic total occlusion score 3: An interesting combination of reversal of wire upgradation and miniature balloon

We represent a case of interesting right coronary artery chronic total occlusion (CTO) revascularization where traditional wire upgradation failed to cross the CTO. Downgrading it to a Miracle 3 wire, the lesion was successfully crossed. It was further dilated with the smallest balloon (NIC Nano 0.85 mm × 6 mm), followed by serial dilation with bigger size balloons. The present manuscript conveys a message that the rule of thumb of wire upgradation during CTO revascularization does not yield in success always, it is the downgradation of the wire which can also achieve success. CTO revascularization although it has some fixed principles, sometimes, a permutation and combination even giving a fair try with wire downgradation can achieve success.