Recanalization of coronary artery chronic total occlusion by retrograde approach

Abstract

Introduction Chronic total occlusion (CTO) is defined as a 100% obstruction of the blood vessel lumen with Thrombolysis in Myocardial Infarction grade 0 flow in the occluded segment at least three months old. Advancement of technological devices and techniques used during the percutaneous coronary interventions (PCI) in the past years brought more success in blood vessel recanalization. According to the latest guidelines for myocardial revascularization, the CTO treatment should be considered when there are symptoms or objective proof of viability or ischemia in the occluded area. The aim of this work is to present two cases with a recanalization of the coronary artery CTO by the retrograde approach. Outline of cases The first patient had a single vessel coronary disease which led to a decision to first attempt PCI. During the attempt of antegrade recanalization, the guidewire penetrated subintimally, risking blood vessel dissection below the occluded area as well as serious complications. Retrograde approach enabled easier and safer passing of guidewire through the occlusion and then successful establishment of the antegrade flow. In the second case, the antegrade approach was also first attempted. Since it could not pass through the occluded area despite changing several guidewires, the strategy was changed during the intervention. It was continued with the retrograde approach, which led to the successful revascularization. Conclusion These two cases demonstrate that retrograde approach and new technological improvements in dedicated guidewires can be implemented in everyday angiography practice for successful recanalization of CTO lesions.

New developments, treatment options and possible complication in complex coronary artery disease, structural and congenital heart disease and heart failure

“…and devices for the treatment of coronary artery disease, structural heart diseases, including valvular and congenital heart disease, as well as heart failure, have changed the practice of modern cardiology. In this issue of the Serbian Archives of Medicine we present five articles on different novel techniques, devices, as well as complications of device implantation for the treatment of chronic total occlusion [1], aortic valve disease [2], patent ductus arteriosus [3], pacemaker systems upgrade [4], and finally critical analysis of the most common complications during the implantation of cardiac rhythm management devices [5].…”

“…Now, with this proctoring approach and large gained experience in implementation of this procedure, several our centers are successfully performing this procedure [6]. Ivanović et al [1] presented two cases of a specific retrograde approach for the treatment of chronic total occlusion where after failed anterograde crossing of the occlusion, the occluded coronary artery was crossed from the contralateral coronary artery through collaterals. The rationale of this approach is based on the fact that the distal cup of coronary ar-tery occlusion is thinner and more suitable for guidewire penetration in comparison with the proximal cup of the occlusion.…”