Use of the kissing microcatheter technique to exchange a retrograde wire for an antegrade wire in the retrograde approach to intervention in chronic total occlusion.

The retrograde approach to chronic total occlusions (CTOs) is a great advance in percutaneous coronary intervention (PCI). When the retrograde wire has been passed into the antegrade guiding catheter, a microcatheter is advanced into the antegrade guiding catheter and the retrograde wire is exchanged for a 0.014 inch, 300 cm guidewire to keep both ends accessible. However, this maneuver takes a long time, as advancing the guidewire is slowed due to marked resistance. We report a case where successful retrograde recanalization of an RCA CTO lesion was performed using the "kissing microcatheter technique". This technique involves placing a microcatheter inside the antegrade guiding catheter and manipulating the retrograde guidewire to pick up the tip of the antegrade microcatheter and enter it retrogradely. The retrograde microcatheter and antegrade microcatheter are on the same retrograde wire. After advancing the antegrade microcatheter until both tips kiss each other, the antegrade microcatheter is advanced to the distal portion of the CTO lesion, pulling the retrograde microcatheter back. The retrograde guidewire is pulled out and an antegrade guidewire is advanced to the distal true lumen through the antegrade microcatheter. This novel technique is a safe, feasible strategy for placing an antegrade guidewire across a CTO lesion.