1. Stenting after retrograde recanalization of Ao-RCA bypass and LAD chronic total occlusion . Case presentation А. Osiev Novosibirsk State Research Institute Of Circulation Pathology Ministry of Health and Social Development of the Russian Federation

3. Antegrade attempt was unsuccessful During the procedure antegrade recanalization of RCA: -blood pressure sharply decreased from 140 torr to 70 torr -severe chest pain

4. Coronary wire : LCA – С x – RCA - Ao-RCA bypass - aortic arch. Balloon dilatation . Antegrade stent implantation What to do now in this situation? Our response : we decided to perform a retrograde recanalization CABG?!

5. After stent implantation 5 BMS : - relief of chest pain -restoration of blood pressure

6. Follow up 4 months Results : - reocclusion CABG - return angina Implantation of 4 DES

7. Follow up 10 months Results : restenosis DES Laser ablation . Excimer laser catheter « Spectranetics » . The final result

8. The next step ???

9. Retrograde catheterization of LAD with coronary wire and Corsair catheter (Asahi Intecc) Collaterals DA-LAD

10. Coronary wire with Corsair catheter in Ao-DA bypass - DA- LAD

11. Coronary wire was trapped by “goose neck” retriver. Right femoral artery – Ao-DA bypass - DA- LAD – Left femoral artery loop was formed After stent implantation

12. Follow up 1 year LAD without significant restenosis Ao-RCA bypass without significant restenosis