Retrograde Technique:

 
Cardiac interventionalists are now using special guide wires and catheters that are gently steered across the total blockages. cardiologists use the "retrograde" approach, in which total coronary blockages are accessed from collateral blood vessels. Collateral blood vessels are new blood vessels that form to reroute blood flow around a blockage, and develop when the severity of a blockage increases. 

Over the past few years, success rates with the combined percutaneous approach have increased from about 60% to 80-85% (in comparison to success rates of about 98% for percutaneous treatment of non-total blockages). Various devices used are Tornus, Corsair and BridgePoint system. The novel antegrade wire based techniques are contrasr guided STAR, Mini-STAR, LAST and device based technique the BridgePoint system. The retrograde techniques which revolutionizes the treatment of total blockage are retrograde wire crossing, CART and the reverse CART.





Retrograde Technique: Reverse CART Technique




Retrograde Technique: CART Technique

Angioplasty of Bypass Surgery Graft


Progression of disease in native coronary arteries occurs in approximately 5 % of patients annually during first 10 years. 


At 10 years, only 40% of patent grafts are free of significant stenosis. Arterial grafts are superior. As compared with Saphenous graft (SVG), internal mammary grafts conferred a survival advantages throughout a 15 years follow up. Angoplasty of SVG grafts is rapidly changing and continues to be an ongoing challenge for the interventional cardiologist. As compared to angioplasty of  native vessels, graft vessel angioplasty is associated with sub-optimal results, increased major adverse cardiac events and less favorable long-term results. The arrival of stents, better antithrombotic medication, distal protection and thrombectomy devices have made it possible to attempt interventions in larger number of patients and obtain favorable results.


Why Angioplasty is preferred over second (Redo) bypass surgery


  • Limited myocardium now in jeopardy if some grafts are patent
  • Risk to patent grafts during resternotomy 
  • Lack of suitable conduits
  • Poor LV function
  • Advanced age 
  • Co-existing medical problems.


SVG graft disease


Atheromas begin to appear at 3-5 years


  • Atheromas are frequently bulky and friable
  • “Silent” thrombus is common


Treatment options


  • Direct Stenting 
  • Embolic Protection ( proximal, distal protection)
  • Vasodilators
  • Thrombus management
  • Undersized stent
  • Net Protective Stent MGUARD