Korean Circ J.  2012 Sep;42(9):625-628. 10.4070/kcj.2012.42.9.625.

Reverse Controlled Antegrade and Retrograde Subintimal Tracking in Chronic Total Occlusion of Right Coronary Artery

• Kim YH
• Hwang SH
• Lim CH
• An HM
• Kim HJ
• Moon SG
• Kang WY
• Hwang SH
• Kim W
• Kim W

• KMID: 2297894
• DOI: http://doi.org/10.4070/kcj.2012.42.9.625

Abstract

Passage failure of guidewire is still remained most common reason for percutaneous coronary intervention (PCI) failure in chronic total occlusion (CTO). Intravascular ultrasound study (IVUS) and cardiac CT angiography can help identify features that most influence current success rates of PCI. We report our experience using the reverse controlled antegrade and retrograde subintimal tracking technique under the aid of IVUS, cardiac CT angiography for an ambiguous CTO of proximal right coronary artery.

Keyword

Angioplasty; Coronary occlusion; Chronic disease

MeSH Terms

Angiography
Angioplasty
Chronic Disease
Coronary Occlusion
Coronary Vessels
Percutaneous Coronary Intervention
Track and Field

Figure

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  Fig. 1 Images of pre-interventional coronary angiography. Chronic total occlusion of the proximal right coronary artery (A) with grade 3 collateral flow from the left anterior descending artery (B) revealed by coronary angiography. A small vessel of the proximal portion of right coronary artery (arrow) appears to be the conus branch (A).

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  Fig. 2 Computed tomography (CT) coronary angiography of chronic total occlusion. Segmental calcified and soft plaques of proximal right coronary artery (RCA) with chronic total occlusion (CTO) were detected in cardiac CT angiography (A and B). A small branch of the proximal portion of the RCA (arrow) was considered a tapered-type CTO lesion rather than a conus branch by coronary angiography and intravascular ultrasound (C).

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  Fig. 3 "Reverse CART technique". The wires pass via septal branch to mid-distal right coronary artery (RCA) via retrograde approach (A and B). The percutaneous transluminal coronary angioplasty for proximal RCA and mid RCA was performed. In addition, 3 drug-eluting stents were deployed (C). Final angiographic result showed good distal flow without residual stenosis (D). CART: controlled antegrade and retrograde subintimal tracking.

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