A step-by-step guide to mastering retrograde coronary chronic total occlusion intervention in 2018: The author's perspective

Figures

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  Fig. 1. Illustration of retrograde true lumen puncture.

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  Fig. 2. Illustration of kissing wire technique.

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  Fig. 3. Illustration of the controlled antegrade and retrograde subintimal tracking.

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  Fig. 4. (A) Coronary angiogram revealing 95% lesion of the ostium and total occlusion at the proximal right coronary artery (RCA). (B) Werner's collateral channel grade 2 from the left anterior descending artery (LAD) to the RCA. (C) Retrograde navigation of guidewire though septal collateral using a microcatheter. (D) Antegrade navigation of guidewire in RCA with microcatheter support. (E) Antegrade 3 × 18 mm balloon dilatation. (F) Advancement of retrograde guidewire with microcatheter into the antegrade guide. (G) Final result after predilatation with 3 × 20 mm balloon and deployment of 3.0 × 38 mm and 4.0 × 33 (from distal to proximal) overlapping drug-eluting stents.

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  Fig. 5. Connection of antegrade and retrograde channels for successful retrograde cross (strategy based on guidewire position).

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  Fig. 6. Dealing with difficulties in connecting antegrade and retrograde spaces in classical reverse CART. CART, controlled antegrade and retrograde subintimal tracking; IVUS, intravascular ultrasound; STRAW, subintimal transcatheter withdrawal.

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  Fig. 7. Schematic illustration of contemporary reverse controlled antegrade and retrograde subintimal tracking.

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  Fig. 8. Algorithm of putting it altogether in CTO PCI.39 CART, controlled antegrade and retrograde subintimal tracking; IVUS, intravascular ultrasound; MDCT, multidetector computed tomography.