Successful retrograde treatment of a mid left anterior descending artery chronic total occlusion using a novel "guide parallel to wire" technique

Antegrade crossing of a chronic total occlusion adjacent to a large side branch may fail. We describe a patient in whom a chronic total occlusion of the proximal left anterior descending artery was successfully crossed retrogradely through an apical collateral after a failed antegrade crossing attempt. No balloon was long enough to reach the left anterior descending artery lesion retrogradely. A retrograde Whisper wire was snared though an antegrade left main guide catheter introduced via the radial approach. We were unable to retrieve the wire via the radial guide catheter because of wire fracture during withdrawal. Externalization of the retrograde guidewire required use of a Frontrunner catheter and removal of the antegrade guide catheter. The lesion was predilated with a retrograde balloon inserted without a guide over the retrograde wire. A 5F guide catheter was introduced next to the retrograde wire through the radial sheath ("guide parallel to wire" technique) followed by successful antegrade crossing and stenting of the mid left anterior descending artery lesion.