Case 255: Manual of CTO PCI - Retrograde through an occluded SVG

A patient with prior CABG presented with angina and was found to have a distal RCA CTO with occlusion of the SVG-PDA. The RCA CTO had a blunt cap, length of approximately 25 mm, and diffusely diseased distal vessel that was filling via epicardial collaterals from the OM and LAD. A primary retrograde strategy was selected because the distal vessel was diffusely diseased. A Gladius Mongo was advanced through a Corsair microcatheter to the PDA. The Corsair was advanced to the proximal PDA, followed by puncture of the distal cap with Gaia Next 2 wire. A Gladius Mongo was advanced to the distal RCA followed by successful reverse CART and externalization of an R350 wire. A Sasuke microcatheter was used to advance a workhorse guidewire into the right posterolateral, followed by stenting with a nice final result.