Triple-Access Retrograde Chronic Total Occlusion Intervention Through Vein Graft and Epicardial Collaterals

Area of Science:

• Interventional Cardiology
• Cardiovascular Medicine
• Medical Imaging

Background:

• Coronary artery disease (CAD) remains a leading cause of mortality worldwide.
• Totally occluded coronary arteries (CTO) present significant challenges for revascularization.
• Retrograde approaches via collateral circulation are crucial for CTO interventions.

Purpose of the Study:

• To describe and evaluate a novel triple-access technique for complex coronary artery recanalization.
• To assess the utility of triple-access in optimizing collateral visualization during retrograde CTO interventions.

Main Methods:

• A retrograde approach was employed to recanalize a totally occluded right coronary artery (RCA) via the saphenous vein graft (SVG) to the obtuse marginal artery (OM).
• Due to limited visualization via SVG, a triple-access strategy was implemented, including injection via the left main coronary artery.
• This technique facilitated improved visualization of epicardial collaterals and the distal RCA.

Main Results:

• The triple-access approach provided enhanced visualization of collateral pathways and the target vessel.
• This facilitated a more effective retrograde recanalization strategy in a complex CTO case.
• The technique demonstrated potential for improving procedural success in challenging CTO interventions.

Conclusions:

• Triple-access is a valuable technique for selected complex coronary total occlusion (CTO) cases.
• It significantly aids in visualizing collateral circulation, crucial for successful retrograde approaches.
• This method offers a potential advancement in interventional cardiology for treating complex CTOs.