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Published on: November 19, 2019
Retrograde approach to coronary chronic total occlusion via an occluded saphenous bypass graft: a case report
Wesam A Alhejily1, David F Kong2, E Magnus Ohman3
1Division of Cardiovascular Medicine, Department of Medicine, Duke University Durham, North Carolina.
Insights
Retrograde percutaneous coronary intervention (PCI) using an occluded vein graft successfully treated a chronic total coronary occlusion. This approach provides a novel access route for complex coronary interventions.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Chronic total coronary occlusion (CTO) presents significant challenges for percutaneous coronary intervention (PCI).
- Traditional antegrade PCI approaches may be limited in CTO cases, particularly involving the ostium.
Observation:
- A case of chronically occluded right coronary artery ostium was successfully treated using a retrograde approach.
- An occluded saphenous vein graft served as the access route to the distal coronary bed.
Findings:
- The retrograde PCI strategy enabled the delivery of interventional equipment to the target lesion.
- Successful revascularization was achieved despite the complex CTO anatomy and unusual access route.
Implications:
- Occluded saphenous vein grafts can be repurposed as a viable conduit for retrograde PCI in CTO.
- This technique expands the armamentarium for treating complex coronary artery disease, offering hope for previously untreatable lesions.
Key Clinical Message:
Retrograde coronary intervention of chronic total coronary occlusion remains challenging. We describe a successful retrograde intervention of chronically occluded right coronary artery ostium via an occluded vein graft. An occluded saphenous vein graft can be a useful means to access the distal coronary bed, enabling delivery of retrograde percutaneous coronary intervention (PCI) equipment.
