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[Successful recanalisation of chronic total occlusion using retrograde approach]
Dominika Dykla1, Danuta Sorysz, Tomasz Rakowski
1II Klinika Kardiologii, Instytut Kardiologii, Uniwersytet Jagielloński Collegium Medicum, Kraków. ddykla@gmail.com
Insights
Successful retrograde percutaneous coronary intervention (PCI) effectively treated chronic total occlusion (CTO) in a patient with angina. This approach offers a viable alternative when traditional methods fail, improving cardiac function and survival.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Chronic total occlusion (CTO) signifies a coronary vessel blockage (TIMI 0 flow) exceeding 3 months.
- Successful recanalization of CTO enhances left ventricular function and patient survival.
- The retrograde technique is indicated for CTO when antegrade approaches are challenging or unsuccessful, particularly in patients with robust collateral circulation.
Observation:
- A 68-year-old male presented with exertional angina, necessitating coronary angiography.
- Coronary angiography revealed a CTO of the right coronary artery (RCA) with collateral supply from the left anterior descending artery (LAD).
- An initial attempt at an antegrade approach in 2004 proved unsuccessful.
Findings:
- A retrograde approach was employed for the percutaneous coronary intervention (PCI) procedure.
- The PCI procedure was successfully completed without any complications.
- This demonstrates the efficacy of the retrograde technique in complex CTO cases.
Implications:
- The retrograde approach is a valuable strategy for managing complex CTOs, especially when antegrade attempts fail.
- Successful CTO recanalization via retrograde PCI can lead to improved cardiac outcomes and survival.
- This case highlights the importance of considering alternative interventional techniques for challenging coronary occlusions.
Abstract:
Chronic total occlusion (CTO) is defined as an occlusion of a coronary vessels (TIMI 0 flow) lasting longer than 3 months. Successful recanalisation of CTO improves left ventricular function and survival. Retrograde technique can be used in patients, who have well-developed collaterals, when the antegrade approach is ineffective or difficult to perform. A 68-year-old male was referred for coronary angiography because of exercise angina chest pain. Coronary angiogram showed a CTO of RCA with collaterals from LAD. Following the unsuccessful traditional antegrade approach in 2004, we attempted a retrograde approach. The PCI procedure was performed successfully and without complications.