Distal LAD filling from homocollaterals – coronary angiogram

Distal LAD filling from homocollaterals – coronary angiogram

Distal LAD

Coronary angiogram showing distal LAD filling from homocollaterals

Left coronary angiogram showing total occlusion of left anterior descending coronary artery with retrograde filling of distal LAD from homocollaterals. LMCA: Left main coronary artery; LCX: Left circumflex coronary artery. Here the collaterals are seen originating from a major diagonal branch of the LAD. The diagonal is originating proximal to the total occlusion and is a sizable vessel supplying homocollaterals (from the same vascular territory) to distal LAD. A right coronary injection would have shown whether there are hetero collaterals (from another vascular territory).

Visualization of collaterals is very important while planning a retrograde approach for recanalization in chronic total occlusions. In CTOs it may not be possible to recanalize from antegrade approach, hence the role for retrograde approach. Retrograde wire crossing may be successful only in 30 – 50% of cases. If simple retrograde crossing is not achieved, other techniques are CART and reverse CART. CART stands for controlled antegrade and retrograde subintimal tracking [1]. Though for usual wire tracking we avoid subintimal tracking for fear of perforation, here it is a cautious subintimal tracking. Both left and right coronary arteries are cannulated during these complex procedures and often simultaneous angiograms of both sides obtained.

Reference

  1. Dash D. Retrograde Coronary Chronic Total Occlusion Intervention. Curr Cardiol Rev. 2015 Nov 6;11(4):291-298.