"Late-late" retrograde collateral filling from occluded donor coronary artery

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Biology

Background:

• Coronary artery disease (CAD) is a leading cause of mortality worldwide.
• Chronic total occlusions (CTOs) present significant challenges in revascularization.
• Antegrade and retrograde approaches are established strategies for CTO percutaneous coronary intervention (PCI).

Observation:

• A unique case involving retrograde flow from a chronically occluded right coronary artery (RCA) to an acutely occluded left anterior descending (LAD) artery was observed.
• The "late-late" antegrade filling pattern of the LAD via collateral circulation from the RCA was a key diagnostic finding.

Findings:

• Successful recanalisation of the acutely occluded LAD was achieved.
• The retrograde filling pattern from the CTO RCA served as a crucial angiographic roadmap for the intervention.
• This case highlights the importance of recognizing complex collateral pathways in CTO PCI.

Implications:

• This case demonstrates the potential of retrograde collateral flow from a CTO vessel to supply a critically occluded artery.
• Understanding and utilizing these "late-late" filling patterns can improve PCI success rates in complex CTO cases.
• This approach may offer a viable revascularization strategy for patients with limited antegrade options.