The retrograde approach to coronary chronic total occlusion interventions

The results of percutaneous coronary interventions (PCI) dramatically improved in the last decades. Despite this improvement chronic total coronary occlusions (CTO) still remain a major challenge of interventional cardiology due to the complexity of these lesions. Retrograde recanalization proved to be one of the most significant amendments of the technique. Careful assessment of the occluded vessel, the donor artery and the interventional collaterals has fundamental importance for a safe and efficient procedure. High‐quality diagnostic angiogram and other imaging methods also have paramount importance for the success. The proper selection of the vascular access for retrograde CTO PCI can be challenging in patients with peripheral artery disease because of special requirements toward the guiding catheters. The latest publications demonstrated continuous improvement in the results together with decreasing complication rates of retrograde procedures. This technique significantly increased the number of patients who can be treated with PCI even with failed previous antegrade attempt.