Simultaneous Right Coronary Total Occlusion and Aortoiliac Revascularization: A Single-session Endovascular Strategy in an Octogenarian STEMI Patient

Severe aortoiliac occlusion can complicate device placement during primary percutaneous coronary intervention (PCI). This presents additional challenges when immediate coronary management is required. We report a single-stage endovascular approach to restore vascular access and achieve complete revascularization. An 87-year-old male with a history of smoking and diabetes presented with ST-elevation myocardial infarction and chest pain. Coronary angiography revealed a total occlusion of the right coronary artery. Severe aortoiliac stenosis restricted catheter insertion. To overcome this, iliac angioplasty was performed to restore vascular access. Reentry allowed continuation of the PCI using a drug-eluting stent to bypass the calcified area. Both interventions were safe and effective, resulting in immediate clinical improvement. He was discharged on standard therapy. This case underscores the need to acknowledge peripheral artery disease as a limiting factor during primary PCI. Iliac revascularization is a crucial intermediate step in facilitating coronary access. A comprehensive cross-vascular approach is essential for managing complex cardiovascular cases.