Retrograde Direct Wire Crossing of Stumpless LAD CTO via Ipsilateral Collateral Using Portal Technique and Ping-Pong Guide Catheter

Abstract

Proximal cap ambiguity in chronic total occlusion (CTO) is associated with increased procedural complexity, lower success rates, longer procedure time and greater use of retrograde approaches. Conventional angiography makes it challenging for interventionists to accurately identify the entry point, easily misdirecting the GW into the subintimal space, leading to PCI failure. We reported a 45-year-old male with CTO of the mid left anterior descending artery (LAD) with an ambiguous proximal cap. We used a Ping-Pong technique with two guide catheters (GC)s and intravascular ultrasound (IVUS) was used to identify the proximal cap. Retrograde wiring was performed through an ipsilateral collateral from diagonal artery, successfully crossed the LAD CTO and externalized into the antegrade GC. Firstly, the rendezvous and “tip-in” method were used, followed by the kissing microcatheter (MC) and chasing wires technique, which successfully revascularized the CTO.