[Successful recanalisation of RCA CTO using retrograde approach]
Marek Król1, Bartosz Skwarna, Paweł Buszman
1I Oddział Kardiologiczno-Angiologiczny, Polsko-Amerykańskie Kliniki Serca, 43-450 Ustroń. drkrol@gmail.com
Insights
A challenging coronary artery disease case was treated using a retrograde approach for chronic total occlusion (CTO) via epicardial collaterals, successfully restoring blood flow. This technique offers a viable option for complex CTO interventions post-coronary artery bypass grafting (CABG).
Area of Science:
- Interventional Cardiology
- Cardiovascular Disease Management
Background:
- Coronary artery bypass grafting (CABG) is a common treatment for severe coronary artery disease.
- Chronic total occlusions (CTOs) pose significant challenges in revascularization, especially after prior CABG.
Observation:
- A 51-year-old female, two years post-CABG, presented with unstable angina and inferior wall ischemia.
- Coronary angiography showed an occluded graft to the right coronary artery (RCA) and a CTO of the RCA with collateral supply from the left anterior descending (LAD) artery.
Findings:
- Successful recanalization of the RCA CTO was achieved using a retrograde approach through epicardial collaterals originating from the distal LAD.
- Antegrade angioplasty with dual stent implantation resulted in restored TIMI 3 flow, indicating successful reperfusion.
Implications:
- This case highlights the efficacy of retrograde CTO intervention via epicardial collaterals in complex post-CABG scenarios.
- The retrograde approach provides a valuable strategy for treating CTOs that are otherwise inaccessible via conventional antegrade methods, improving outcomes for patients with diffuse coronary artery disease.
Abstract:
A 51-year-old female two years after CABG presented with unstable angina and inferior wall ischaemia. Coronary angiography revealed occluded graft to RCA and chronic total occlusion of RCA with good collateral flow from distal LAD to RCA. The CTO was successfully crossed and dilated through epicardial collaterals from distal LAD (retrograde approach). Finally, antegrade angioplasty with two stents implantation was performed achieving TIMI 3 flow.
