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Pestilence
Picking this up instead of Shogun is very much something you can do if there is a lot of healing in the enemy team.
Stone of Gaia
If the enemy team has a lot of knockup, knockback, pull or grab abilities, feel free to grab this, it provides a ton of health which will help with abusing the Blood-Soaked Shroud. Though it offers no protection stats, so be wary.
Spectral Armor
In this patch, we are going to see a lot more crit builds coming from the duo lane. This item is perfect for that and the removal of boots allows us to build Spectral armor comfortably as we don't really need to sacrifice an item slot for it anymore.
Ethereal Staff
This is a solid option for a late-game item slot as it provides health, power and it steals 8% max mana and 6% max health from targets hit with abilities + 20% CCR, which can be a lifesaver.
Celestial Legion Helm
This could be built instead of Tyrannical, though I don't see much reasoning for it, it can definitely be viable.
Hero's Axe
Ignoring the Blood-Soaked Shroud and going for Sundering Axe start can bring you a HUGE team-fight advantage, providing allies with 15% of your maximum health whenever they are hit with a hard CC ability. This item is going to be picked up A LOT in this patch I believe.
Genji's Guard
You can pick this up for the Shogun's if you feel it's worth it. it provides the 10% CDR needed, provides health and provides a superior amount of magical protection, as well as a neat passive that lowers your cooldowns more!
Honestly ignore anything below this I don't have time to read it and review it, it might be outdated or true, IDK, I'm just here to provide updated builds.
This is by no means a full guide on Cthulhu, I just wanted to share my thoughts on how to build Cthulhu in this new patch and share with you the success that I've had with playing him in the meta.
Just a warning, since we are Cthulhu and we are building a lot of health, with extensive health given on the ultimate, Qin Sais built by hunters can shred you very fast. To counteract this, we build thorns and should pop them before ulting into a teamfight to try to mitigate this a bit. If you have a team, they should be able to easily capitilise to the CC and destruction you will inflict on your opponent via your ultimate :)
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Overgrowth Thorns "Using this item reflects 25% of all damage you take, before mitigations, for the next 5 seconds, back to its owner as Magical Damage. If you are dealt 120 * your level damage while this effect is active, the effect will end early. While this is active enemies can only lifesteal from you for 50% of their total lifesteal. Additionally, you gain a stack of 5% Movement Speed and Attack Speed for all Enemy Gods within a 55 unit radius. Cooldown - 120s." (Compared to T2: 5% less reflect, anti-lifesteal drops from 75% to 50%)
Sapping Strength Thorns "Using this item reflects 35% of all damage you take, before mitigations, for the next 3 seconds, back to its owner as Magical Damage. If you are dealt 120 * your level damage while this effect is active, the effect will end early. While this is active enemies can only lifesteal from you for 75% of their total lifesteal. Each basic attack from enemy gods reduces the cooldown of this item by 0.5s. Cooldown - 80s. " (Compared to T2: low cd is nice but it only being 3 sec in duration is just bad which just sucks hard cause it would otherwise be a nice direct upgrade)