The retrograde approach for percutaneous coronary intervention, using multiple arterial accesses for contralateral injection and large guiding catheters (7-8 Fr), has largely improved the success rate of recanalization of chronic total occlusions (CTOs). Radial approach and downsizing in this type of intervention are challenging. Our cases series demonstrates that in selected anatomies it is possible, feasible, and safe to perform single 6 Fr transradial guiding catheter retrograde recanalization of left-sided CTO via ipsilateral epicardial or septal collateral channels.
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