CORONARY - Chronic Total Occlusion
Retrograde Chronic Total Occlusion Intervention in Right Coronary Artery
Jayanta Saha1, Kuntal Bhattacharyya1
Kolkata Medical College & Hospital, India1,
A 60-year-old hypertensive male patient presented with CCS 3 angina for the last 3 months. He had an inferior wall myocardial infarction 4 months back, which was not thrombolyzed due to late presentation and managed conservatively. Physical examination was unremarkable.
Blood reports showed hemoglobin 13.6 gm/dl, creatinine 0.9 mg/dl, FBS 92 mg/dl, LDL 110 mg/dl.ECG showed Q waves in inferior leads.Echocardiography showed inferior wall hypokinesia with preserved ejection fraction of 55% and good RV function.
Coronary angiogram revealed:Normal left systemRight Coronary Artery was dominant. There was a long segment CTO from proximal part, with distal refilling of the vessel through septal collaterals from LAD.
Antegrade approach, though preferred in most CTO interventions, is not always successful. Retrograde approach is a good alternative in those cases. Appropriate collateral selection is the key to success. Comprehensive knowledge of all instruments and wires is essential for a favorable outcome.