Use of sodium nitroprusside in retrograde percutaneous coronary intervention for chronic total occlusion: A case report

RATIONALE: Chronic total occlusion continues to be a challenging lesion subset for percutaneous coronary intervention. PATIENT CONCERNS: A 65-year-old male patient was admitted with symptoms of angina pectoris for 9 months. DIAGNOSES: Coronary angiography showed a severe stenosis in the proximal left anterior descending artery and a chronic total occlusion (CTO) in the proximal right coronary artery. The complexity of the CTO was stratified using the J-CTO score and the PROGRESS CTO score. INTERVENTIONS: Antegrade wire escalation for CTO of RCA failed. The septal collaterals to RCA were initially judged to be poor and not suitable for intervention. OUTCOMES: However, administration of sodium nitroprusside improved collateral flow and enabled the identification of retrograde channels suitable for wire crossing and successful retrograde PCI. LESSIONS: The study showed that faintly visible to even invisible septal collateral connections can be crossed with the septal “trial and error” surfing technique after the administration of sodium nitroprusside.