Video : Retrograde RCA CTO PCI through epicardial collaterals

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Cardiology / Coronary / Pci / Case in the box

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This complete didactic procedure concerns a 68 yo male, with history of LAD PCI. The coronary angiography has also shown proximal RCA Chronic Total Occlusion with residual proven ischemia.

This Proximal RCA Chronic Total Occlusion was recanalized retrogradely through epicardial collaterals with good final result.

Educational objectives

How to manage patients with coronary CTO.
How to apply the Hybrid algorithm during coronary CTO procedures.
How to perform antegrade Knuckle wire Technique.
How to select & approach epicardial collaterals.
How to perform Reverse CART Technique.

Step-by-Step Procedure

Double Access: Right Femoral 7F, Left Radial 6F.
Dual injection & angiographic evaluation.
Antegrade approach using Turnpike Spiral (Teleflex) & Fielder XT-A (Asahi) and then Gaia 3rd guidewire (Asahi).
Antegrade wire Knuckling to the distal RCA using Fielder XT-A.
Distal re-entry failure with Pilot 200 (Abbott).
Retrograde Approach using epicardial collaterals from Left Cx: Sion guidewire (Asahi) & Turnpike LP (Teleflex).
Revere CART technique using a 3.5x20mm balloon, guideliner V3 support (Teleflex) & Pilot 200 guidewire (Abbott).
Predilatation.
Stenting with multiple DES Supraflex (Teleflex).
Left system microcatheter removing & control.
Final result.

Protocol

Procedural time: 120min.
Contrast medium: 310ml (Ultravist)
Exposure: 1.6 Gy.
Fluoroscopic time: 65min.

Biobliography

Optimal approach to percutaneous intervention for CTO in 2017: a hybrid strategy is now the preferred choice - Editorial
Authors: Simon J. Walsh, MD, FRCP; Colm G. Hanratty, MD, FRCP; James C. Spratt, MD, FRCP
Epicardial collateral channel for retrograded recanalization of chronic total occlusion percutaneous coronary intervention: Predictors of failure and procedural outcome.- Article
Authors: Huang Z, Ma D, Zhang B, Folson AA, Lin J, Wu K, Liao H, Zhong Z.
Publication: 2018 Feb;31(1):23-30. doi: 10.1111/joic.12441. Epub 2017 Sep 19
Outcomes of the retrograde approach through epicardial versus non-epicardial collaterals in chronic total occlusion percutaneous coronary intervention. - Article
Authors: Benincasa S, Azzalini L, Carlino M, Bellini B, Giannini F, Zhao X, Colombo A.
Publication: 2017 Sep;18(6):393-398. doi: 10.1016/j.carrev.2017.03.013. Epub 2017 Mar 14.
Retrograde approach for the recanalization of coronary chronic total occlusion: collateral selection and collateral related complication. - Article
Authors: Ma JY, Qian JY, Ge L, Fan B, Wang QB, Yan Y, Zhang F, Yao K, Huang D, Ge JB.
Publication:2013 Mar;126(6):1086-91.
Intracoronary snaring of the retrograde guidewire: How to overcome extreme takeoff angles in chronic total occlusion percutaneous coronary intervention. - Article
Authors: Azzalini L, Candilio L, Carlino M, Colombo A.
Publication:2018 Feb 15;91(3):464-469. doi: 10.1002/ccd.27324. Epub 2017 Sep 25.

Shooting date : 2018-10-30
Last update : 2021-05-11

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See previous comments (3)

hashemi fard O. Excellent

2018-11-23, 21h09
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omer S. thank you. very good job.

2019-01-20, 10h24
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Nihat O. Exclude final viwe good job

2019-01-20, 14h22
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Muhammad Asghar K. Excelent and very educational

2019-01-20, 18h25
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Pecheux M. Vert pedagogic

2019-01-21, 18h51
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Deogenes M. Amazing video

2019-01-22, 5h12
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albayrak S. Z

2019-01-22, 11h49
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Retrograde RCA CTO PCI through epicardial collaterals

Case of the month: January 2019

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