scholarly journals Recanalization of coronary artery chronic total occlusion by retrograde approach

2017 ◽  
Vol 145 (11-12) ◽  
pp. 627-631
Author(s):  
Vladimir Ivanovic ◽  
Milenko Cankovic ◽  
Igor Ivanov ◽  
Jadranka Dejanovic ◽  
Anastazija Stojsic-Milosavljevic ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Blood Vessel ◽  
Chronic Total Occlusion ◽  
Myocardial Revascularization ◽  
Retrograde Approach ◽  
Total Occlusion ◽  
Antegrade Approach ◽  
Pass Through ◽  
Antegrade Flow ◽  
Vessel Dissection

Introduction. Chronic total occlusion (CTO) is defined as a 100% obstruction of the blood vessel lumen with Thrombolysis in Myocardial Infarction grade 0 flow in the occluded segment at least three months old. Advancement of technological devices and techniques used during the percutaneous coronary interventions (PCI) in the past years brought more success in blood vessel recanalization. According to the latest guidelines for myocardial revascularization, the CTO treatment should be considered when there are symptoms or objective proof of viability or ischemia in the occluded area. The aim of this work is to present two cases with a recanalization of the coronary artery CTO by the retrograde approach. Outline of cases. The first patient had a single vessel coronary disease which led to a decision to first attempt PCI. During the attempt of antegrade recanalization, the guidewire penetrated subintimally, risking blood vessel dissection below the occluded area as well as serious complications. Retrograde approach enabled easier and safer passing of guidewire through the occlusion and then successful establishment of the antegrade flow. In the second case, the antegrade approach was also first attempted. Since it could not pass through the occluded area despite changing several guidewires, the strategy was changed during the intervention. It was continued with the retrograde approach, which led to the successful revascularization. Conclusion. These two cases demonstrate that retrograde approach and new technological improvements in dedicated guidewires can be implemented in everyday angiography practice for successful recanalization of CTO lesions.

scholarly journals The retrograde technique for recanalization of chronically occluded coronary arteries: Case series report

2020 ◽  
pp. 124-124
Author(s):  
Stefan Juricic ◽  
Milorad Tesic ◽  
Milan Dobric ◽  
Srdjan Aleksandric ◽  
Zlatko Mehmedbegovic ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Case Series ◽  
Interventional Cardiology ◽  
Coronary Artery Occlusion ◽  
Artery Occlusion ◽  
Special Technique ◽  
Retrograde Approach ◽  
Total Occlusion ◽  
Antegrade Approach ◽  
Increased Risk

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.

scholarly journals Recanalization of Chronic Total Occlusions Using Modern Endovascular Techniques

Kardiologiia ◽  
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.

scholarly journals Interventricular Septal Hematoma after Retrograde Intervention for a Chronic Total Occlusion of a Right Coronary Artery: Echocardiographic and Magnetic Resonance Imaging—Diagnosis and Follow-Up

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Makoto Araki ◽  
Tadashi Murai ◽  
Yoshihisa Kanaji ◽  
Junji Matsuda ◽  
Eisuke Usui ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Magnetic Resonance ◽  
Right Coronary Artery ◽  
Chronic Total Occlusion ◽  
Rare Complication ◽  
Interventricular Septum ◽  
Success Rates ◽  
Retrograde Approach ◽  
Total Occlusion

The reverse CART technique provides the potential to modify the retrograde procedure by improving the controlled movement of the retrograde wire and improve the success rates of percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). Development of interventricular hematoma is a rare complication of CTO PCI. A 63-year-old man with effort angina with a right coronary artery CTO lesion underwent PCI by retrograde approach from the LAD to a septal branch. A contrast “stain” was demonstrated surrounding the septal collateral channel used for the retrograde approach at the end of the procedure without symptom. Echocardiography indicated an increased interventricular septum thickness with low echo signals region and decreased contractility. Cardiac magnetic resonance (CMR) imaging using gadolinium showed a diffusely thickened septum with a low signal fusiform neocavitation delimited by an enhanced-signal ring suggesting intraventricular septal dissecting hematoma. After conservative treatment, follow-up echocardiogram and CMR showed the resolution of the hematoma without clinical events. This case highlights the potentially lethal complication of septal perforator dissection and hematoma that may cause severe myocardial injury caused by retrograde approach for CTO PCI.

scholarly journals Retrograde Approach to Chronic Total Occlusion Percutaneous Coronary Intervention

2020 ◽  
Vol 13 (5) ◽  
Author(s):  
Michael Megaly ◽  
Iosif Xenogiannis ◽  
Nidal Abi Rafeh ◽  
Dimitri Karmpaliotis ◽  
Stephane Rinfret ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Success Rate ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Retrograde Approach ◽  
Total Occlusion ◽  
Antegrade Approach ◽  
Percutaneous Coronary ◽  
Complex Lesions

The retrograde approach has increased the success rate of chronic total occlusion percutaneous coronary intervention but has also been associated with a higher risk of complications. The retrograde approach is usually performed in complex lesions, in which the antegrade approach is not feasible or has failed previously. Using a systematic 10-step approach can maximize the likelihood of success and minimize the risks of retrograde chronic total occlusion interventions.

scholarly journals s Chronic total occlusion in ostium of right coronary artery – retrograde approach as the first-choice method of revascularization?

2013 ◽  
Vol 4 ◽  
pp. 337-340 ◽  
Author(s):  
Leszek Bryniarski ◽  
Tomasz Kameczura ◽  
Sławomir Surowiec ◽  
Bogdan Januś ◽  
Bogusław Derlaga ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Chronic Total Occlusion ◽  
Retrograde Approach ◽  
Total Occlusion ◽  
First Choice ◽  
Choice Method

scholarly journals Reverse longitudinal stent deformation during percutaneous intervention via the retrograde approach to a chronic total occlusion of the right coronary artery: a case report

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Claudia Cosgrove ◽  
Marciej Marciniak ◽  
James C Spratt
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Chronic Total Occlusion ◽  
Unusual Complication ◽  
Mechanical Complication ◽  
Retrograde Approach ◽  
Total Occlusion ◽  
Guide Catheter ◽  
Stent Deformation ◽  
Coronary Stent Implantation

Abstract Background Longitudinal stent deformation (LSD) is an uncommon but recognized mechanical complication of coronary stent implantation, usually occurring at the proximal stent edge due to compression by guide catheter or catheter extensions. Retrograde techniques for chronic total occlusion (CTO) percutaneous coronary intervention expose the distal stent edge to potential interaction with retrograde equipment under a tensioned system. Case summary We describe a case of distal stent edge LSD, occurring during a retrograde approach to a right coronary artery CTO via septal collateral channels. While removing the externalized wire, interaction with the retrograde microcatheter caused compression of the distal end of the newly implanted stents. Discussion This unusual complication highlights the reduced longitudinal strength of newer generation stent platforms and the risks of interaction between retrograde equipment and stents on an externalized wire.

scholarly journals Case Report: RETROGRADE APPROACH FOR CTO LESIONS: SERIAL CASE

2017 ◽  
Vol 52 (4) ◽  
pp. 296
Author(s):  
Yudi Her Oktaviono
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Coronary Bypass ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Retrograde Approach ◽  
Total Occlusion ◽  
Term Survival ◽  
Antegrade Approach ◽  
Percutaneous Coronary

Chronic total occlusion recanalization still represents the final frontier in percutaneous coronary intervention. Successful revascularization is associated with improved long-term survival, reduced symptoms, improved left ventricular function and reduced need for coronary bypass surgery. Retrograde chronic total occlusion recanalization has recently become an essential complement to the classic antegrade approach. Retrograde approach through the collateral channel has been recently proposed and has the potential to improve the success rate of percutaneous coronary intervention (PCI) in chronic total occlusion (CTO) lession of the coronary arteries. We report several cases of successful CTO recanalization procedure using retrograde approach in Soetomo Hospital.

scholarly journals Rotational Atherectomy-Assisted Crossing of a Complex Right Coronary Artery Lesion Using the Retrograde Approach

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Abdul-Subulr Yakubu ◽  
Xiaoqiang Zhang ◽  
Bin Zhang
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Rotational Atherectomy ◽  
Retrograde Approach ◽  
Total Occlusion ◽  
Interventional Cardiologist ◽  
Percutaneous Coronary

Chronic total occlusion lesions present a major challenge for the interventional cardiologist. In this case, we report the successful use of rotational atherectomy to facilitate retrograde percutaneous coronary intervention of a complex totally occluded right coronary artery after modification of the proximal cap of the lesion to enable placement of the RotaWire in the vessel architecture.

Sign in / Sign up

Export Citation Format

Share Document