Interv Akut Kardiol 2012; 11(3-4): 162-164

The retrograde recanalization of left circumflex artery chronic total occlusion with the use of the left radial approach

Jan Pešek, Ivo Bernat, Jiří Koza, Michal Šmíd, Richard Rokyta

Kardiologické oddělení, Komplexní kardiovaskulární centrum FN Plzeň, LF v Plzni, UK v Praze

Introdution: The radial approach minimizes the risk of local bleeding complication. The use of this approach is possible even in complex

coronary intervention.

Case report: A 66-year-old woman with effort angina underwent coronary angiography in our department in April 2008. She was referred

for multivessel disease to cardiac surgery, the quadruple coronary artery bypass was performed. For recurrent effort angina several

month after cardiac surgery, nuclear stress test was performed, with inducible ischemia of lateral wall. During coronary angiography,

tight stenosis in distal anastomosis of venous graft into obtuse marginal branch and total ostial occlusion of left circumflex artery were

diagnosed. On November 2008 elective PCI was made, with use of combined femoro-radial approach, the femoral approach was indicated

for antegrade recanalization of left circumflex, the radial approach for visualization of distal segment via venous graft. Due to failure of

antegrade recanalization, the transradial retrograde approach via venous graft was used during the same procedure. After successful

retrograde wiring with hydrophillic wire and retrograde balloon dilatation, the transfemoral antegrade stenting with two drug-eluting

stents was performed. The femoral puncture site was closed by AngioSeal closing device, the radial puncture site was closed by TR-Band.

The patient was discharged the next day to home care, with no complication during follow-up.

Conclusion: A case report demonstrates successful retrograde recanalization of chronic total occlusion using the radial approach.

Keywords: percutaneous coronary intervention, chronic total occlusion, radial approach

Published: May 11, 2012  Show citation