ST‐Elevation myocardial infarction as a complication of retrograde chronic total occlusion recanalization

Abstract

With the advent of new tools and techniques including the retrograde approach, success rates for recanalization of chronic total occlusion (CTO) have improved. Numerous cardiac and extracardiac complications during retrograde CTO recanalization have been described. To date the development of ST-segment elevation myocardial infarction (STEMI) with retrograde recanalization as a result of atheroembolization has not been reported. We report such a case following retrograde recanalization of a totally occluded right coronary artery.

Retrograde CTO recanalization of RCA SVG from the contralateral LAD SVG: “Coast to coast” revascularization with FFR in between

“…In concert with this case was their first report of the use of pressure wire in retrograde CTO [1]. In that case, the retrograde CTO recanalization was complicated by atheroembolism and STEMI.…”

“…The University of Arkansas group, headed by Drs. Uretsky and Sachdeva have previously presented their experience with retrograde chronic total occlusion (CTO) revascularization [1] and now shows us another remarkable CTO procedure [2], traversing a left anterior descending (LAD) apical collateral (grade 3) via an LAD saphenous vein graft (SVG) to revascularize the RCA SVG and posterior descending artery (PDA). In addition to going “coast to coast” across the heart, they also used a pressure wire to examine the collateral physiology and fractional flow reserve (FFR).…”

“…Using the retrograde CTO approach operators can successfully recanalize vessels that previously were thought untreatable by PCI, expanding the PCI population to include patients with non‐functional SVGs due to distal anastomosis occlusion. Of course this technical tour de force is not without risk, one of which is noted in their report of STEMI following CTO recanalization [1].…”