The Retrograde Approach

Updated on May 18, 2019
Allison Hall, Emmanouil S. Brilakis


The retrograde approach offers an alternate crossing strategy when it is not feasible to cross a coronary chronic total occlusion (CTO) in the antegrade direction. In the retrograde approach, a guidewire and microcatheter are advanced through a collateral vessel or bypass graft into the distal true lumen. The occluded segment is then crossed using a variety of techniques, followed in most cases by guidewire externalization, balloon angioplasty and stenting.

Evolution and Contemporary Use

The retrograde technique has evolved significantly over time. Its initial description dates back to 1990 when Kahn and Hartzler performed balloon angioplasty of a left anterior descending artery CTO through a saphenous vein graft (SVG) 11. Kahn JK, Hartzler GO. Retrograde coronary angioplasty of isolated arterial segments through saphenous vein bypass grafts. Cathet Cardiovasc Diagn. 1990;20:88-93. Link. In 2006, the use of septal collaterals for retrograde CTO crossing was first reported by Japanese operators, followed by rapid adoption in Europe and the US 2, 3, 4, 5, 6, 7, 8, 9, 102. Surmely JF, Tsuchikane E, Katoh O et al. New concept for CTO recanalization using controlled antegrade and retrograde subintimal tracking: the CART technique. J Invasive Cardiol. 2006;18:334-8. Link3. Wu...

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