Angioplasty of an occluded left anterior descending coronary artery: usefulness of retrograde opacification of the distal part of the occluded vessel via the contralateral coronary artery in positioning the balloon catheter.

A 59 year old man was admitted to hospital with a non-transmural anterior myocardial infarction. Recurrent angina pectoris eight days after the initial infarction was investigated by cardiac catheterisation, which showed moderate anterior hypokinesis and proximal occlusion of the left anterior descending coronary artery. The distal part of this vessel was opacified via collaterals from the right coronary artery. Percutaneous transluminal coronary angioplasty was attempted during the same catheterisation; good positioning of the balloon catheter was confirmed by the use of retrograde opacification of the distal part of the left anterior descending coronary artery via the collateral vessels and dilatation was safely achieved. Opacification of the contralateral coronary artery may be a useful and safe positioning of guide wire system or balloon dilatation catheter when dilatation of a totally occluded coronary artery is attempted.