Retrograde recanalization of a chronic ostial occlusion of the left anterior descending artery: how to manage extreme takeoff angles.

Chronic total coronary occlusions (CTO) still remain one of the most technically challenging clinical scenearios in which to perform interventions. Although the antegrade approach is the most common method of CTO recanalization, a retrograde attempt improves the success rate and its usagehas been increasingly adopted in the recent years. However, the retrograde method requires exceptional expertise and skills in order to apply a wide variety of strategies, devices and imaging modalities. We report a case of retrograde recanalization of an ostial left anterior descending artery CTO of at least 10 years duration, and discuss some specific issues of a new channel dilating catheter, and practical precautions to keep in mind in the retrograde approach such as the availability of snare technique to facilitate retrograde wire capture and externalization.