Drug-eluting balloon angioplasty improves the distal run-off in retrograde chronic total occlusion revascularization

Abstract

To the Editor, This is the case of a 72-year-old male examined due to exertional angina, and severe inferior wall ischemia through a single-photon emission computed tomography with Tc-99. After obtaining the patient’s written informed consent he was referred for a coronary angiography that confirmed the chronic total coronary occlusion (CTO) of the proximal right coronary artery (RCA) (figure 1A) with a J-CTO score of 3 (blunt entry shape, lesion > 20 mm, and calcification), and the presence of septal collaterals from the left anterior descending coronary artery (figure 1B, video 1 of the supplementary data). Initial antegrade approach was planned that quickly had to be changed for the retrograde approach due to the unfavorable characteristics of the lesion. Figure 1. A: total occlusion of proximal RCA. B: septal collaterals from the left anterior descending coronary artery. C: externalized retrograde wire from the septal collateral crossing the right coronary artery occlusion. D: antegrade wiring with the help of a microcatheter placed in the distal right coronary artery. E: angiographic result after occlusion predilatation and stenting with TIMI grade-1 flow. F: after drug-eluting balloon, TIMI grade-3 flow is achieved with a diseased distal vessel. After surfing across the septal collateral channels, the distal cap...