Retrograde Percutaneous Coronary Intervention for Left Anterior Descending Chronic Total Occlusion Via an Ipsilateral...

Area of Science:

• Cardiovascular Interventions
• Interventional Cardiology
• Vascular Biology

Background:

• Successful recanalization of coronary artery chronic total occlusion (CTO) improves patient outcomes.
• The retrograde approach offers higher success rates for CTO but is not universally applicable.
• Intraseptal collateral channels can supply the distal left anterior descending (LAD) artery in CTO cases.

Observation:

• A specific CTO case involved distal LAD supply via an intraseptal collateral channel.
• The controlled antegrade and retrograde tracking (CART) strategy enhances guidewire crossing and recanalization success.
• A retrograde percutaneous coronary intervention was performed for the LAD CTO lesion.

Findings:

• The procedure utilized an ipsilateral intraseptal collateral channel for retrograde access.
• A reverse CART technique was successfully employed for guidewire crossing and lesion crossing.
• Successful revascularization of the LAD CTO was achieved using a single 8-French guiding catheter.

Implications:

• This case demonstrates the feasibility and success of the reverse CART technique for complex LAD CTO via intraseptal collaterals.
• The findings suggest that this approach can be a valuable option when standard retrograde methods are unsuitable.
• Optimizing CTO treatment strategies can further improve patient symptoms and long-term mortality.