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A Case Report on Percutaneous Coronary Intervention in Chronic Total Occlusion by Retrograde Visualization
M A Muqueet1, M Mahmood, M H Hoque
1Dr Mohammad Abdul Muqueet, Associate Professor, Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh;
Insights
Utilizing a bilateral femoral artery approach for chronic total occlusions (CTO) allows visualization of retrograde flow. This technique aids in guiding wires for successful antegrade recanalization of complex coronary artery disease.
Area of Science:
- Interventional Cardiology
- Vascular Surgery
- Cardiovascular Imaging
Background:
- Chronic total occlusions (CTO) present significant challenges in percutaneous coronary intervention.
- Retrograde flow visualization is crucial for successful antegrade recanalization strategies.
- Bilateral arterial access techniques are emerging for complex CTO interventions.
Observation:
- A case of CTO in the left anterior descending (LAD) artery is presented.
- Bilateral femoral artery access was employed for simultaneous contrast injection.
- Retrograde flow in the LAD was visualized via contralateral artery cannulation.
Findings:
- The bilateral femoral access facilitated detailed visualization of retrograde flow.
- Simultaneous contrast injections provided anatomical roadmap for antegrade wire progression.
- Successful antegrade recanalization of the CTO was achieved using this approach.
Implications:
- Bilateral arterial access, particularly using femoral arteries, offers a valuable strategy for CTO interventions.
- Enhanced visualization through contralateral injections improves procedural success rates.
- This approach may become increasingly reported for complex coronary interventions.
Abstract:
As bilateral approach is paramount in chronic total occlusions with retrograde flow, the use of two radial arteries, two femoral arteries or combination technique using one radial and one femoral artery will probably be increasingly reported in the near future. After puncture of opposite groin, a diagnostic 6 Fr catheter is used to intubate the ostium of the contralateral artery. By visualizing the distal vessel in multiple projections, contralateral injections help to direct the progression of the wire in the occluded segment towards the distal true lumen and confirm the intraluminal position of the wire after the occluded segment. We are reporting a case with chronic total occlusion where we used bilateral femoral access and simultaneous contrast injection to visualize retrograde flow in LAD while opening CTO through ante-grade pathway.
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