The novel use of retrograde CTO PCI techniques as a rescue strategy for an acute right coronary artery occlusion due to iatrogenic dissection.

Coronary artery dissection is a known complication of percutaneous coronary intervention (PCI). Such dissections are often treated by antegrade PCI. When antegrade PCI fails, the options become limited to conservative management or coronary artery bypass grafting (CABG). CABG comes with its own risks, and conservative management can result in a potentially larger infarct. Here we present a novel use of retrograde chronic total occlusion (CTO) PCI techniques to treat an iatrogenic, type D dissection of the right coronary artery in a young male with an acute coronary syndrome. Reentrance of the true lumen by standard antegrade approaches failed. The rescue strategy using a retrograde CTO PCI approach not only had advantages over surgery and conservative management, but also over antegrade PCI. A soft wire, designed for collaterals, was used to "surf" the dissection and reach the antegrade guiding catheter. Thus, the true lumen could be used. This novel approach provided the advantages both of preserving major side branches, which are often lost with antegrade PCI approaches, and of not unnecessarily puncturing the dissection membrane. <Learning objective: Extensive iatrogenic coronary artery dissections not amenable to antegrade PCI are typically managed conservatively or by CABG. A novel, bail-out strategy using retrograde CTO PCI techniques provided another treatment strategy. A soft wire, designed for collaterals, was used to "surf" the dissection and reach the antegrade guiding catheter. This method has the great advantage of preserving major side branches, which are often lost with antegrade PCI approaches.>.