Retrograde approach for percutaneous treatment of chronic total occlusions of coronary arteries

Abstract

Coronary artery chronic total occlusions are diagnosed in about 20% of coronary angiograms, nevertheless, percutaneous recanalization of these lesions is under attempted. Theses patients usually have incomplete percutaneous revascularization or are referred for coronary artery bypass surgery. Current improvements in the interventional armamentarium along with innovative approaches led to a marked increase in recanalization success rates, even in the most complex anatomic scenarios. Retrograde approach techniques are considered an essential part of the skillset for chronic total occlusion dedicated operators, and is probably the most difficult step to master. Refinements in the retrograde technique were paramount to achieve the safety and efficacy current standards. The authors propose a step-by-step guide for operators wanting to embrace this strategy.