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Retrograde microcatheter cannot
cross the lesion: tips & tricks
Roberto Garbo, MD
San Giovanni Bosco Hospital, Turin, Italy
Background
• Retrograde approach improved recanalization success rate
in CTO interventions.
• In principle retrograde CTO crossing could be “easier” than
antegrade because the distal cap is usually softer than the
proximal.
• However, in some cases, CTO recanalization still remain
difficult even with retrograde approach.
• Even in presence of a “good” retrograde collateral channel,
difficulties may be encountered in crossing the channel
and then the CTO.
Before retrograde crossing
of the CTO…
Reach it !!!
ANCHORING BALLOON
EFFECTIVE
Corsair and Finecross™
NOT CROSSING septal
57 y male, previous primary PCI on prox-mid LAD
Prox RCA CTO (2nd attempt)
septal branch surfing…
CORSAIR NOT CROSSING SEPTAL
2nd septal branch dilatation (1.25 mm balloon)
at the ostium
(through LAD stent) distally
… to facilitate Corsair™ advancement
65 years-old male, previous
mid LAD PCI
OM CTO with several CTO
PCI antegrade attempts
and residual
RETROGRADE option
Turnpike LP™ 150 cm
Collateral navigation: Sion Regular™
Failed crossing with Turnpike LP™
Anchoring
balloon
Deep
intubation
Exchange with
Finecross™ 150 cm
and advancement
Retrograde crossing with
Ultimate3™ wire
FINAL RESULT
When the distal cap of the
CTO is reached…
Cross it !!!
68y woman, anterior
ischemia (SPECT).
Previous primary PCI
on mid RCA + PCI prox
LAD /Dg1
Corsair™ doesn’t cross
septal branch
Finecross™ successful
Finecross™ in front of CTO
distal CAP (heavy calcific
LAD…)
REVERSE CART
Ultimatebros 3™ wire
retrograde crossing
Sapphire II PRO™
1.0 mm
CORSAIR & FINECROSS™ FAILURE IN RETROGRADE
CROSSING (DESPITE RETROGRADE WIRE TRAPPING)
Successful Corsair™
retrograde crossing
Sapphire II PRO™
dilatation
FINAL RESULT
J-CTO SCORE: 4
56y man, previous PCI on LAD and prox LCx + distal
LCx PCI failure. Persistent effort angina CCS III
Dual arterial access with 8 Fr right femoral and
6 Fr right radial artery EBU 8 French 90 cm
2nd Antegrade attempt failure
Fielder XT-A, Gaia 2 and Conquest Pro unsuccessful
CorsairFinecross
Retrograde approach via ipsilateral
epicardial channel from distal LAD
DES 2.5/12 mm
Collateral channel crossing
Collateral channel crossing
Retrograde CTO
crossing
(Fielder XT-A)
Retrograde approach via ipsilateral
epicardial channel from distal LAD
Corsair and FineCross 150 unable to retrograde
crossing despite retrograde wire trapping and
Guideliner (severe calcified lesion).
Guideliner
Ping pong technique
XT-A
“Tip-in" technique
Switch from XT-A to RG3 but
RG3 stucked into the 6 Fr
catheter
Finecross 130 antegrade
(bare)
Finecross advanced through
Retrograde RG3 guidewire
(then carried in front of
calcified stenosis)
Antegrade Finecross 130
unable to cross CTO
Antegrade rotawire into retrograde
Finecross 150
“Rendez-vous” technique
Rotational atherectomy
(1.25 and 1.50 mm burr)
Retrograde
Finecross
Retrograde
Finecross
FINAL RESULT
Conclusions / Take Home message
• Retrograde approach in CTO recanalization still
represent a challenge in interventional cardiology.
• Even in presence of a “good” retrograde collateral
channel, difficulties may be encountered in crossing
the channel and then the CTO.
• Dedicated materials and operators’ experience are the
Key to overcome this difficulties and reach CTO-PCI
success.

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