Management of Chronic Total Occlusion With Heavily Calcified Distal Cap: Three-Dimensional Vascular Wall Assessment Enables Move-the-Cap Technique via Retrograde Approach.

The complexity of chronic total occlusion percutaneous coronary intervention (CTO PCI) involving calcification is high, and completing the procedure with an antegrade approach is often challenging. However, calcification is also a significant obstacle in the retrograde approach, where it has been reported as a predictor of CTO PCI failure even after successful channel crossing. Overcoming calcification in the retrograde approach is, therefore, crucial.