July 27, 2026 · JACC. Cardiovascular interventions · DOI: 10.1016/j.jcin.2026.05.022

Retrograde CTO PCI via Epicardial Collaterals: Techniques, Tools, and Risk Mitigation

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This review addresses the challenges and techniques associated with retrograde percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) via epicardial collaterals, particularly when septal collaterals are not viable. The authors aim to provide interventionalists with practical guidance on the latest devices and methods to enhance safety and efficacy, while also discussing strategies for risk mitigation during these complex procedures.

Paola Scarparo, Pierfrancesco Agostoni, Omer Goktekin, Carlo di Mario, Alexandre Avran, Kambis Mashayekhi, Roberto Diletti

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