Backyards of Chronic Total Occlusion

Abstract

Chronic total occlusion (CTO) remains a challenging lesion subset in percutaneous coronary intervention and endovascular treatment because of low initial procedural success rates and high rates of restenosis at the chronic stage. There are only a few reports of human pathologic specimens of CTO in the literature.1 Angioscopy has been reported to be useful for the direct visualization of thrombus and allows for characterization of the vessel wall from inside,2 but we cannot observe the distal side of CTO in coronary arteries. Here we report an evaluation of the distal side of CTO of the superficial femoral artery (SFA) via a retrograde approach with angioscopy. ### Case 1 A 71-year–old man with hypertension, dyslipidemia, and type 2 diabetes mellitus noticed intermittent claudication in both legs in 2003. He received endovascular treatment of the left iliac artery in 2003 and that of the right iliac artery in 2008. The symptom, however, recurred in 2010, and medical treatment failed to improve it. He received another endovascular treatment for the right SFA. Control angiography revealed a short total occlusion in the right SFA (Figure 1A and Movies I and II in the …