Retrograde-angioscopy guided wiring technique in chronic total occlusion lead to successful revascularization

Endovascular therapy (EVT) was performed in two cases with chronic total occlusion (CTO) of superficial femoral artery. In these cases, angioscopy was deployed in the backyard of the CTO lesion from popliteal artery retrogradely, then the guidewire was advanced from antegrade. When the wire crossed the distal of the CTO lesion, the wire penetration was clearly visualized by the retrograde-angioscopy. Therefore, wire crossing of CTO into the distal true lumen was certainly confirmed, and EVT was successful. <Learning objective: Angioscopy-guided endovascular therapy for chronic total occlusion was useful not only to evaluate thrombus and plaque in situ visually, but also to successfully perform guidewire crossing.>.