Goranov Georgi, Petrov Petko
Section of Cardiology, First Department of Internal Medicine, Medical University of Plovdiv, 15A Vassil Aprilov Blvd., 4002, Plovdiv, Bulgaria.
Department of Maxillofacial Surgery, Faculty of Dental Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria.
J Med Case Rep. 2025 May 23;19(1):247. doi: 10.1186/s13256-025-05313-z.
With the development of specialized equipment and the retrograde technique, success rates for percutaneous coronary intervention of chronic total occlusions have increased from 60 to 90% in the past 10 years. Performing percutaneous coronary intervention via a collateral channel from the contralateral artery, using two guiding catheters, is usually the preferred approach to retrograde chronic total occlusion-percutaneous coronary intervention. In the case described in this report, we performed successful retrograde revascularization of chronic total occlusion of dominant left circumflex artery via the ipsilateral septal collateral artery from the left anterior descending artery. The procedure was performed successfully through radial artery access using a single guiding catheter. An 85-year-old white Bulgarian Caucasian male patient, with a history of lateral and inferior myocardial infarction 20 years ago and previous percutaneous coronary intervention, underwent a planned coronary arteriography owing to his complaints of typical angina symptoms. Coronary angiography revealed three-vessel coronary artery disease with patent implanted drug-eluting stents in the mid-left anterior descending artery and in the proximal right coronary artery and chronic total occlusion of dominant left circumflex artery. A septal branch in the midsegment of left anterior descending artery was supplying the distal left circumflex artery retrogradely. After repeated failed attempts at antegrade percutaneous coronary intervention for the left circumflex artery's chronic total occlusion, the retrograde approach was tried. This intervention finally succeeded through the ipsilateral septal collateral. It was performed via a single radial artery access throughout the whole process. Postoperatively, the patient had no complications and was stable at the 6-month follow-up.
The transradial approach to retrograde percutaneous coronary intervention for chronic total occlusions via an ipsilateral septal collateral using a single guiding catheter is feasible and safe in appropriately selected cases.
随着专业设备和逆行技术的发展，在过去10年中，慢性完全闭塞病变经皮冠状动脉介入治疗的成功率已从60%提高到90%。使用两根引导导管，经对侧动脉的侧支通道进行经皮冠状动脉介入治疗，通常是逆行慢性完全闭塞病变经皮冠状动脉介入治疗的首选方法。在本报告所述的病例中，我们通过发自左前降支的同侧间隔侧支动脉，成功地对优势左旋支动脉慢性完全闭塞病变进行了逆行血运重建。该手术通过桡动脉入路使用单根引导导管成功完成。一名85岁的保加利亚白人男性患者，有20年前侧壁和下壁心肌梗死病史及既往经皮冠状动脉介入治疗史，因典型心绞痛症状就诊，接受了计划性冠状动脉造影。冠状动脉造影显示三支血管冠状动脉疾病，左前降支中段和右冠状动脉近端植入的药物洗脱支架通畅，优势左旋支动脉慢性完全闭塞。左前降支中段的一个间隔分支逆向供应左旋支动脉远端。在对左旋支动脉慢性完全闭塞病变进行顺行经皮冠状动脉介入治疗多次失败后，尝试了逆行方法。该介入治疗最终通过同侧间隔侧支成功完成。整个过程均通过单根桡动脉入路进行。术后，患者无并发症，在6个月随访时情况稳定。
在适当选择的病例中，经桡动脉入路，使用单根引导导管，通过同侧间隔侧支对慢性完全闭塞病变进行逆行经皮冠状动脉介入治疗是可行且安全的。
