Successful revascularization of right coronary artery chronic total occlusion by the antegrade and retrograde approaches

Yuan Han, Quanmin Jing, Yanbin Su, Wei Wang


The treatment of chronic total occlusion (CTO) of coronary arteries allowed for a remarkable improvement in success rates and is represented by the introduction of the “Hybrid algorithm”. An inability to cross the occlusion with a guidewire is the most common cause of failure of CTO revascularization. As antegrade options are limited, intervention upon the extreme angulation of the coronary artery warrants a retrograde approach. Here, we report a 58-year-old man with symptoms of effort angina complicated with three-vessel disease and CTO of the right coronary artery (RCA). Left main artery bifurcation lesions were treated with systematic two-stent strategies and intervention upon RCA CTO after three months by means of a combination of the antegrade and retrograde approaches. The RCA was eventually revascularized by the implantation of stents, and no adverse events were observed during hospitalization.