The open retrograde approach as an alternative for failed percutaneous access for difficult below the knee chronic total occlusions—A case series

Background. Chronic total occlusion (CTO) of coronary artery still represents one of the most challenging lesion subset in field of interventional cardiology. Considering the complexity and increased risk posed by the retrograde approach, it is most often performed after a failed antegrade approach. Methods. We present a series of cases dedicated to the retrograde approach as a special technique for the treatment of chronic total coronary artery occlusion. All cases have some special characteristics that are today part of a dedicated portfolio in every cath lab. Results. In our series of cases all of three percutaneous coronary interventions (PCI) with retrograde approach finished with successful recanalization of CTO with different strategy and supported with rotational atherectomy (RA) or intravascular ultrasound (IVUS). Conclusion. In cases where there is the presence of interventional collaterals, as well as when the anterograde approach is very difficult, the retrograde approach can increase the success rate of procedures. The retrograde approach requires a long learning curve as well as very skilled and experienced operators who are able to perform the procedure independently.

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Recanalization of Chronic Total Occlusions Using Modern Endovascular Techniques

Kardiologiia ◽

10.18087/cardio.2019.2.10225 ◽

2019 ◽

Vol 59 (2) ◽

pp. 10-16

Author(s):

D. A. Khelimskii ◽

O. V. Krestyaninov ◽

A. G. Badoyan ◽

D. N. Ponomarev ◽

E. A. Pokushalov

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Coronary Intervention ◽

Retrograde Approach ◽

Endovascular Techniques ◽

Total Occlusion ◽

Chronic Total Occlusions ◽

National Medical ◽

Antegrade Approach ◽

Percutaneous Coronary

Purpose:to assess results of percutaneous coronary intervention (PCI) with contemporary endovascular techniques of recanalization of chronic total coronary artery occlusions (CTO) in patients with ischemic heart disease (IHD). Occlusion (CTO) he procedural and in-hospital outcomes of consecutive patients undergoing chronic total occlusion percutaneous coronary intervention.Materials and methods.We retrospectively analyzed data from 456 consecutive patients (mean age 59.9±7.1 years, 18.2 % women) who underwent CTO PCI procedures (n=477) during 2014–2016 in the E. N. Meshalkin National Medical Research Center. CTO was localized in the right (61.2 %), left anterior descending (23.2 %) and left circumflex (15.3 %) coronary arteries. In one patient CTO was located in the left main coronary artery. According to the J-CTO score, 30 % of lesions were classified as easy, 36.4 % intermediate, 23.7 % difficult, and 18.9 % very difficult.Results.Technical and procedural successes were achieved in 374 (78.4 %) and 366 patients (76.7 %), respectively. Antegrade approach was used in 378 (79.2 %), retrograde approach – in 99 (20.7 %) cases. Retrograde approach as primary strategy was used in 27 cases (5.7 %). Most frequent access for CTO PCI was radial artery, contralateral injection was used in 151 cases (31.6 %). Total number of stents per lesion was 1.6±0.98. The mean fluoroscopy time was 36.2±31 min.Conclusions.The rate of procedural adverse events in our study was low and similar to the non-CTO PCI series. However, despite the large number of CTO PCIs, the procedural success rate was still lower than in centers with dedicated programs for the management of such patients. Thus, further work is required to overcome this difference. Possible solution of this problem might be development and introduction in clinical practice of an algorithm for CTO recanalization.

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Comparative Assessment of Crossing and Reentry Devices in Treating Chronic Total Occlusions for Femoropopliteal and Below-the-Knee Interventions

Practical Approach to Peripheral Arterial Chronic Total Occlusions ◽

10.1007/978-981-10-3053-6_6 ◽

2017 ◽

pp. 75-94

Author(s):

Nicolas W. Shammas

Keyword(s):

Comparative Assessment ◽

Chronic Total Occlusions ◽

Below The Knee

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Balloon-Assisted Retrograde Puncture of Distal Vessels in Patients Unsuitable for a Conventional Transpedal Approach

Journal of Endovascular Therapy ◽

10.1177/15266028211068761 ◽

2022 ◽

pp. 152660282110687

Author(s):

August Ysa ◽

Marta Lobato ◽

Ana M. Quintana ◽

Leire Ortiz de Salazar ◽

Roberto Gómez ◽

...

Keyword(s):

Arterial Occlusion ◽

Chronic Total Occlusions ◽

Tibial Artery ◽

Below The Knee ◽

Angioplasty Balloon ◽

Low Profile ◽

Loop Technique ◽

The Wire ◽

Technique Failure

Purpose: To describe a novel bailout technique to approach below-the-knee chronic total occlusions after a failed bidirectional recanalization attempt using the plantar loop maneuver in patients who are poor candidates for a retrograde puncture. Technique: After a failure of recanalization of the opposite tibial artery using the plantar loop maneuver, an assisted direct retrograde transpedal approach can be performed regardless of poor vessel caliber or even arterial occlusion. After crossing the plantar arch, a low profile angioplasty balloon is used as a landmark for the pedal puncture and to give guidance for the wire advancement from the new access. Conclusion: A balloon-assisted retrograde transpedal approach may be considered for below-the-knee recanalization after standard plantar loop technique failure in patients who are not candidates for conventional retrograde puncture.

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