A novel intravascular ultrasound-guided percutaneous coronary angioplasty technique via the retrograde approach for chronic total occlusion

The retrograde approach via native channels, mainly septal collaterals, has now become routine. However even after retrograde advancement of a catheter through a collateral channel, it is sometimes difficult to guide the catheter from a false lumen into the true lumen. We experienced 3 patients in whom the site for retrograde guidewire re-entry site from the chronic total occlusion was unclear, and intravascular ultrasound (IVUS) was useful for identifying the re-entry site. Here we report on this new technique, in which IVUS guides the retrograde guidewire to its re-entry site.