title: First reported revascularization of complex occlusion of the right coronary artery using the IVUS-guided reverse CART technique via a gastroepiploic artery graft.
abstract: When patients who have previously undergone coronary artery bypass graft surgery develop ischemia symptoms that cannot be controlled by optimal medical therapy, repeat revascularization is indicated. The revascularization strategy should be based on individual clinical and anatomical characteristics. We report here a challenging patient who presented with recurrent stable angina due to worsening of a proximal right coronary artery (RCA) stenosis to chronic total occlusion (CTO) after anastomosis of the right gastroepiploic artery (GEA) to the posterior descending artery. A soft guidewire was advanced through the right GEA collateral channel to the distal end of the CTO, but the dedicated CTO guidewires could not be advanced across the severely calcified CTO using the retrograde wire crossing or kissing wire techniques. The RCA was eventually revascularized by implantation of drug-eluting stents using the intravascular ultrasound-guided reverse controlled antegrade and retrograde subintimal tracking technique.
authors.affiliation: Department of Cardiology, Shu Guang Hospital Bao Shan Branch, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Dai
authors.affiliation: Department of Cardiology, Kusatsu Heart Center, 407-1 Komaizawa-cho, Kusatsu, Shiga, 525-0014, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Katoh
authors.affiliation: Department of Cardiology, Shu Guang Hospital Bao Shan Branch, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Zhou
authors.affiliation: Department of Cardiology, Kusatsu Heart Center, 407-1 Komaizawa-cho, Kusatsu, Shiga, 525-0014, Japan. Kyo_khc_cct@163.com.
authors.forename: Eisho
authors.initials: E
authors.lastname: Kyo
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation; D006328:Cardiac Catheterization; D017023:Coronary Angiography / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D023921:Coronary Stenosis / Q000175:diagnosis / Q000601:surgery*; D018450:Disease Progression; D054855:Drug-Eluting Stents; D024405:Gastroepiploic Artery / Q000637:transplantation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
keywords: Bypass graft; Chronic total occlusion; Controlled antegrade and retrograde subintimal tracking; Intravascular ultrasound