Intracoronary snaring for externalization in Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention

A retrograde approach for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is often required in complex CTOs, and it increases the technical success rate of CTO PCI. Wire externalization after crossing the lesion is often required for further balloon dilatations and stenting. When the retrograde guidewire cannot enter the antegrade guide catheter after lesion crossing, guide extension-assisted or snare-assisted externalization is attempted. Snaring the retrograde wire is usually done in the ascending aorta. We report a case of retrograde CTO PCI, where snaring was done inside the coronary due to difficulty in reaching the aorta.