Doenças Cardiovasculares e Diagnóstico

Successful interventional recanalization against heavily calcified chronic total occlusion of proximal right coronary artery utilizing retrograde guidewire trapping technique at the terminal aorta

Abstract

Masaki Tanabe, Takeo Kunitomo, Osamu Doi

We described a case of chronic total occlusion (CTO) of the ostial right coronary artery (RCA) in a 79-year-old woman that had been undergoing hemodialysis.

Coronary intervention of the ostial RCA-CTO was performed via the retrograde approach. The retrograde hard wire was able to pass through the CTO segment via a transseptal collateral and advanced at the ascending aorta. However, the microcatheter tip could not advance into the heavily calcified plaque of the CTO segment. Moreover, it was very difficult to catch the retrograde hard wire tip in the ascending aorta using a 10mm Gooseneck snare at the ostium of the antegrade guiding catheter due to three-dimensional size mismatch. Thereby, we attempted to cross the occluded segment directly using a long-shaft soft guidewire designed for retrograde CTO intervention (0.009 inch 330 cm). The unassisted long-shaft wire tip was passed successfully through the CTO segment retrogradely. After the retrograde wire tip was pushed ahead of the terminal aorta, it was caught using the former snaring system, and another guiding catheter for the antegrade approach was pulled in. After wire externalization was completed, balloon dilatation and stent deployment through the CTO segment were performed successfully via the antegrade approach.

Here, we report a case of successful interventional revascularization of a heavily calcified and device-uncrossable CTO lesion by the retrograde wire trapping technique using a gooseneck snare device at the terminal aorta. The method in which the capture of a retrograde wire using Gooseneck snare system may be not novel in itself. But, in case of difficulty in uncrossability devices and catching it at the ascending aorta as well, this combinative technique is beneficial to the ease of wire externalization.