Moderator band connections: an unusual route in retrograde chronic total occlusion procedure: moderator band connections as options to right coronary artery chronic total occlusion

Abstract

We describe a right coronary artery (RCA) chronic total occlusion (CTO) percutaneous coronary intervention (PCI) procedure in a very high risk patient, in whom a complex PCI with the support of Impella CP device plus Rotablator rotational atherectomy was performed 6 months ago to revascularize a very calcified left anterior descendent. This was an unusual approach because it was performed through a very rare connection by retrograde technique. It was performed through a third distal septal branch connecting with the moderator band artery. Reverse controlled antegrade and retrograde tracking technique was then successfully performed. After RCA CTO PCI, there was an improvement in the patient symptoms and quality of life. This case highlights the important role of this unusual and rare source of collateral circulation in RCA CTO.