Percutaneous coronary intervention of a circumflex artery chronic total occlusion using the retrograde approach via ipsilateral collateral circulation from the left anterior descending artery

Retrograde recanalization techniques have markedly improved success rates of attempts to open chronic coronary occlusions in symptomatic patients. A contralateral artery with a collateral channel to the distal segment of the occluded artery is traversed and the vessel is then wired and dilated retrogradely. Occasionally only an ipsilateral collateral is available. We describe the first case of retrograde recanalization of a dominant circumflex artery via a septal collateral channel and discuss the issues surrounding the use of the ipsilateral collateral approach to recanalization of a chronically occluded artery.