A “microcatheter anchor technique” to prevent prolapse and facilitate retrograde chronic total occlusion intervention via a retroflexed saphenous vein graft

Chronic total occlusion percutaneous coronary intervention has lower success rates in patients with prior coronary artery bypass graft surgery. Patent or occluded bypass grafts serve as conduits for retrograde recanalization, but a common cause of failure is the acute angulated graft insertion making wiring difficult, with recurrent wire and microcatheter prolapse, if not impossible. We present a case with difficult retrograde wiring and tracking around a retroflexed graft insertion site that was successfully addressed using a strategic balloon to anchor the microcatheter – the "microcatheter anchor technique (MAT)".