New Concept for Chronic Total Occlusion Using Retrograde Approach via the Septal Branch in the RCA

摘要

Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) by the antegrade approach is sometimes difficult, especially in the right coronary artery (RCA). We performed successful PCIs following a retrograde approach via a septal branch in 2 patients with CTO in RCA. In two cases, even a soft retrograde wire crosses the lesion through the true lumen, as confirmed by IVUS in one case. Probably, the distal fibrous cap is soft and the proximal one has a thin point that soft wires, even blunt ones, can penetrate easily. The distal penetration point appears to connect to the proximal uncalcified thin point. Many channels seem to spread out from the proximal side within the lesion. In the retrograde approach, the wire is unlikely to enter these branch channels. The results suggest that PCI by the retrograde approach may be effective for treating CTOs of RCA.