Retrograde approach to recanalising coronary chronic total occlusions immediately following a failed conventional attempt

Chronic total occlusions (CTO) continue to be associated with worse procedural outcomes following percutaneous coronary intervention (PCI) compared with non-occlusive lesions. A number of advances in materials and novel techniques have helped improve procedural success and have stimulated renewed interest in CTO PCI. We present 2 cases in which a conventional antegrade attempt was unsuccessful and resulted in considerable dissection distal to the occlusion. In both patients we employed a retrograde approach using septal collaterals to cross the occlusions retrogradely. This approach proved successful and can be applicable in patients with suitable collateral channels following unsuccessful conventional procedures, even in the same session.