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a fairly common problem where you get a wire into the coronary sinus but you canamp;#39;t get the sheath to track up over the wire in this particular case there was an lb lead that got pulled back and because it was over two years old we were forbidden to pull it out Iamp;#39;m not sure it would have made much difference anyway but you can see we engaged the coronary sinus and got into the middle cardiac vein we actually went down the middle cardiac vein to look to see if there was any options down that way but it didnamp;#39;t collateralize well to the to the main body of the CS so what do you do when you get when you get a glide wire up into the coronary sinus like this but you can advance the sheath so hereamp;#39;s the glide wire went up not so he wasnamp;#39;t so hard to get the glide wire robbed but there was a lot of resistance to trying to advance the sheath and you can see we injected contrast and it looked like it was completely occluded so we gave it a push still wouldn
