Total aorto‐ostial chronic occlusion of the right coronary artery successfully recanalized via retrograde approach

Abstract

Chronic total occlusions remain a technical challenge for interventional cardiologists. This group of lesions carries a decreased rate of success and continues to be an important reason for surgical revascularization. Recently, retrograde percutaneous coronary intervention of total occlusions via epicardial and septal perforators was introduced as an alternative approach when a previous antegrade attempt has failed. We describe a unique case where retrograde approach was used as the initial recanalization technique in the absence of a right coronary ostium.

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

“…However, these methods have caused a number of problems such as guidewire tip damage and difficulty in releasing the snare. 3,4) Furthermore, the techniques are costly and time consuming. The new technique that we have reported here solves these problems and enables the quick and easy insertion of the retrograde guidewire into the antegrade GC.…”

“…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.…”

Comparison of mid-term clinical outcomes between “complete full-metal jacket strategy” versus “incomplete full-metal jacket strategy” for diffuse right coronary artery stenosis with drug-eluting stents

“…As compared to the diffuse long lesion of left anterior descending artery or left circumflex artery, the diffuse long lesion of right coronary artery (RCA) more frequently requires complete coverage by multiple stents from the aorto-ostium [6]. However, the current definition of FMJ does not refer to the complete whole vessel coverage by multiple stents, but only to stent length > 60 mm without gap.…”

“…Stenting for the diffuse long lesion often resulted in full lesion coverage with multiple stents, which is called fullmetal jacket (FMJ). FMJ was defined as total stent length > 60 mm without gap [5].As compared to the diffuse long lesion of left anterior descending artery or left circumflex artery, the diffuse long lesion of right coronary artery (RCA) more frequently requires complete coverage by multiple stents from the aorto-ostium [6]. However, the current definition of FMJ does not refer to the complete whole vessel coverage by multiple stents, but only to stent length > 60 mm without gap.…”

Ostial right coronary chronic total occlusion: Transesophageal echocardiographic guidance for retrograde aortic re‐entry

“…Recently, Nicholson et al described the use of electrocautery for retrograde aortic re‐entry in the setting of an aorto‐ostial RCA CTO . In the setting of an aorto‐ostial occlusion, the RCA ostium may be difficult to visualize angiographically resulting in uncertainty of wire passage within the true lumen during a retrograde approach . In this regard, stiff guidewires or even electrocautery may result in unwanted complications.…”