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Updated: May 30, 2026

Permanent Cerebral Vessel Occlusion via Double Ligature and Transection
Published on: July 21, 2013
How opening two chronic total occlusions may be easier than just one
Andreas Indermuhle1, Martyn Thomas, Simon Redwood
1St Thomas' Hospital, Cardiovascular Division, BHF Centre of Excellence, King's College London, London, United Kingdom. andreas.indermuehle@kcl.ac.uk
Insights
This study presents a novel retrograde approach for recanalizing chronic total occlusions (CTOs) in the right coronary artery (RCA). Using a right internal mammary artery graft, this technique overcomes unfavorable entry angles for improved antegrade revascularization.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Surgery
Background:
- Recanalization of chronic total occlusions (CTOs) is a complex cardiovascular procedure.
- Graft insertion into distal vessels often presents challenging entry angles for antegrade approaches.
- Existing methods for CTO recanalization via grafts have limitations.
Abstract:
Recanalization of chronic total occlusions (CTOs) via grafts has been described previously. However, the insertion of the graft into the distal vessel is often characterized by an unfavorable entry angle which renders an antegrade approach challenging. In the present case, we describe how retrograde recanalization of the proximal right coronary artery (RCA) via a right internal mammary artery graft facilitated antegrade revascularization of the CTO of the RCA.
