1. Advanced CTO Techniques: Retrograde Case Review IX
Shigeru SAITO, MD, FACC
Kamakura & Sapporo, JAPAN

2. Shigeru Saito, MD
I have no real or apparent conflicts of interest to report.

3. Why retrograde approach is necessary?
If we can pass a guidewire through the collateral channels, we can definitely ensure the true lumen distal to the CTO.
By applying the bi-lateral approach,
We can ensure the strongest back-up and/or traction force.
We can straighten any severely tortuous arteries.

4. Why retrograde approach is necessary?
The live case transmitted from Busan National University Yangsan Hospital on April 29 during ANGIOPLASTY SUMMIT-TCTAP 2010 in Seoul, Korea

5. Why retrograde approach is necessary?
The live case transmitted from Busan National University Yangsan Hospital on April 29 during ANGIOPLASTY SUMMIT-TCTAP 2010 in Seoul, Korea

6. Why retrograde approach is necessary?
The live case transmitted from Busan National University Yangsan Hospital on April 29 during ANGIOPLASTY SUMMIT-TCTAP 2010 in Seoul, Korea

7. Why retrograde approach is necessary?
The live case transmitted from Busan National University Yangsan Hospital on April 29 during ANGIOPLASTY SUMMIT-TCTAP 2010 in Seoul, Korea

8. Why retrograde approach is necessary?
The live case transmitted from Busan National University Yangsan Hospital on April 29 during ANGIOPLASTY SUMMIT-TCTAP 2010 in Seoul, Korea

9. Why retrograde approach is necessary?
The live case transmitted from Busan National University Yangsan Hospital on April 29 during ANGIOPLASTY SUMMIT-TCTAP 2010 in Seoul, Korea

10. Why retrograde approach is necessary?
The live case transmitted from Busan National University Yangsan Hospital on April 29 during ANGIOPLASTY SUMMIT-TCTAP 2010 in Seoul, Korea

11. Why retrograde approach is necessary?
The live case transmitted from Busan National University Yangsan Hospital on April 29 during ANGIOPLASTY SUMMIT-TCTAP 2010 in Seoul, Korea

12. A case with CTO of anomalous-origin RCA

13. A case with CTO of anomalous-origin RCA

14. A case with CTO of anomalous-origin RCA

15. A case with CTO of anomalous-origin RCA

16. A case with CTO of anomalous-origin RCA

17. A case with CTO of anomalous-origin RCA

18. A case with CTO of anomalous-origin RCA

19. A case with CTO of anomalous-origin RCA

20. A case with CTO of anomalous-origin RCA

21. A case with CTO of anomalous-origin RCA

22. A case with CTO of anomalous-origin RCA

23. A case with CTO of anomalous-origin RCA

24. Retrograde Approach for Chronic Total Occlusions
Taketani Y, Kaneda H, Saito S. Successful coronary intervention for chronic total occlusion using a retrograde approach with biradial arteries. Invasive Cardiol. 2007; 19: E281-4.
Kaneda H, Takahashi S, Saito S. Successful coronary intervention for chronic total occlusion in an anomalous right coronary artery using the retrograde approach via a collateral vessel. Invasive Cardiol. 2007; 19: E1-4.
Saito S. Different strategies of retrograde approach for CTO lesions. Cathet Cardiovasc Interv 2008; 71: 8-19.
Matsumi J, Saito S. Progress in the retrograde approach for chronic total coronary artery occlusion: a case with successful angioplasty using CART and reverse-anchoring techniques 3 years after failed PCI via a retrograde approach. Catheter Cardiovasc Interv. 2008; 71:
Matsumi J, Adachi K, Saito S. A unique complication of the retrograde approach in angioplasty for chronic total occlusion of the coronary artery.Catheter Cardiovasc Interv. 2008; 72:

25. Summary
For the case with a CTO lesion in the proximal RCA with anomalous origin, I performed the bi-directional approach.
By the use of the guidewire externalization, I could achieve the strong backup support.
According to the situation, we have to change our strategies flexibly.