A Novel Wiring Technique to Insert a Retrograde Guidewire Directly Into the Antegrade Guiding Catheter at the Ascending Aorta for Retrograde Percutaneous Recanalization of an Ostial Coronary Total Occlusion

Abstract

SummaryIn recent years, the use of a retrograde approach has become a common practice in the treatment of chronic total occlusion (CTO) of the coronary ostium and artery with an anomalous origin. Use of this approach has increased the chances of a successful percutaneous coronary intervention (PCI). However, the approach requires capturing the retrograde guidewire within the aorta, which can often pose a problem. Therefore, we developed a technique in which the retrograde guidewire is passed through the CTO and inserted directly into the antegrade guiding catheter in the ascending aorta. This technique enabled the successful treatment of the ostial CTO of the right coronary artery using retrograde PCI. (Int Heart J 2016; 57: 503-506) Key words: Percutaneous coronary intervention, Chronic total occlusion, Retrograde approach, Right coronary ostium W ith the recent popularization of the retrograde approach, the initial success rate of percutaneous coronary intervention (PCI) for treating coronary chronic total occlusions (CTOs) has improved.1) The retrograde approach in particular has enabled initial success in treating CTOs with an anomalous origin as well as those of the coronary ostium, which are difficult to treat using antegrade PCI. However, coaxial positioning of the antegrade guiding catheter (GC) with the coronary artery is difficult in occlusal lesions such as these, which makes it difficult to insert the retrograde guidewire into the antegrade GC.2) Techniques for attaching the retrograde guidewire, such as the use of conventional snares or homemade snares, have been reported. However, these methods are time consuming, costly, and cause associated problems such as retrograde guidewire damage.3,4) We present here the case of a CTO lesion at the inlet of the right coronary artery for which externalization was successfully completed using a novel technique consisting of inserting the retrograde guidewire, which had been passed through the lesion by directly crossing the antegrade GC within the ascending aorta. This technique undoubtedly improved the safety and procedural duration pertaining to retrograde PCI in our case where it was difficult to insert the retrograde guidewire into the antegrade GC. Case ReportThe case subject was an 80-year-old man with coronary risk factors that included diabetes and a history of smoking. Thirteen years prior to the study he developed an anterior myocardial infarction for which a bare metal stent (BMS) was placed in the proximal left anterior descending artery. A BMS was also simultaneously placed in the proximal right coronary artery (RCA). Six years prior to the study, a sirolimus-eluting stent (SES) was placed in the central portion of the RCA to alleviate effort angina. However, shortness of breath on exertion persisted for 3 months so coronary angiography was performed. This confirmed total occlusion of the RCA in the ostium, and the contrast showed the RCA arising from the sinus ( Figure 1A). With respect to the left anterior descending artery (LAD), although th...

Successful Retrograde Visualization and Recanalization of Chronic Ostial Occlusion of the Left Main Coronary Artery via a Saphenous Vein Graft With the Drilled Balloon Technique

“…Web-based research shows there are publications about retrograde coronary interventions via the saphenous vein graft, but there is only 1 case report about successful retrograde recanalization of a chronic ostial occlusive lesion of the LMCA via a saphenous vein graft. 2-6 The drilled balloon technique was not used in these studies. We think that the drilled balloon technique facilitates this process.…”

Improved Propensity-Score Matched Long-Term Clinical Outcomes in Patients with Successful Percutaneous Coronary Interventions of Coronary Chronic Total Occlusion

“…16) However, over the last several years, significant progress in technology, materials, techniques, and operator experience in PCI CTO improved procedural success to almost 90%, and more. [17][18][19][20][21][22] Regarding mortality, a report from the UK Central Cardiac Database showed that successful CTO intervention was associated with improved long-term survival.…”