Percutaneous coronary intervention by retrograde approach for chronic total occlusion of the proximal left anterior descending artery via a gastroepiploic artery graft
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Coronary arteries connecting to septal branch are often occluded in post-coronary artery bypass graft cases. A 70-year-old male had undergone CABG; radial artery graft to the LCX, and gastroepiploic artery (GEA) graft to the RCA. Coronary angiography revealed total occlusion in proximal LAD, while both graft vessels had good flow. Retrograde percutaneous coronary intervention (PCI) procedure from the septal channel via GEA graft to the RCA was performed for total occlusion of LAD. Despite the tortuous GEA, deep engagement with a 4-french guiding catheter ensured powerful back-up force. After retrograde wire crossing, two drug-eluting stents were implanted, successfully.
KeywordsRetrograde procedure Chronic total occluded lesions Gastroepiploic artery
Conflict of interest
Authors have no financial disclosure of conflict of interest to declare.
- 1.Ochiai M. Current retrograde approach to CTO PCI, How to open chronic total occlusions via collateral channels. Cardiac Interventions Today. 2009; pp 50–4.Google Scholar
- 4.Rathore S, Katoh O, Tuschikane E, Oida A, Suzuki T, Takase S. A novel modification of the retrograde approach for the recanalization of chronic total occlusion of the coronary arteries. Intravascular ultrasound-guided reverse controlled antegrade and retrograde tracking. J Am Coll Cardiol Intv. 2010;3:155–64.Google Scholar
- 5.Sumitsuji S, Inoue K, Ochiai M, Tsuchikane E, Ikeno F. Fundamental wire technique and current standard strategy of percutaneous intervention for chronic total occlusion with histopathological insights. JACC Cardiovasc Interv. 2011;4(9):941–51. doi: 10.1016/j.jcin.2011.06.011.PubMedCrossRefGoogle Scholar
- 7.Matsumoto H, Tsuchikane E, Takeda Y, Nishibe A, Kobayashi Y, Nasu K, et al. Successful percutaneous coronary intervention for chronic total occlusion utilizing a retrograde approach via a degenerated saphenous vein graft or collateral vessel: a report on three cases. Jpn J Interv Cardiol. 2003;18:263–7.Google Scholar
- 8.Tsujimoto M, Nishida Y, Shinohara S, Ueda K, Yamazaki M, Kuga Y, et al. A case of successful PCI for chronic total occlusion using the retrograde approach through saphenous vein graft. Jpn J Interv Cardiol. 2009;24:155–60.Google Scholar
- 9.Galassi AR, Tomasello SD, Reifart N, Werner GS, Sianos G, Bonnier H, et al. In-hospital outcomes of percutaneous coronary intervention in patients with chronic total occlusion: insights from the ERCTO (European Registry of Chronic Total Occlusion) registry. EuroIntervention. 2011;7(4):472–9.PubMedCrossRefGoogle Scholar
- 12.Nakamura, S. Jang-Ho Bae. Recent progress of the use of interventional therapy for chronic total occlusion. Korean Circ J. 2008;38:295–300.Google Scholar
- 13.Tanaka K, Nakamura S, Matsumura A, Tanigawa J, Kitano K, Akiyama T. Successful percutaneous coronary intervention for RCA chronic total occlusion utilizing combination of antegrade and retrograde approach via gastroepiploic artery. Jpn J Interv Cardiol. 2002;17:518–23.Google Scholar