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Cardiología Intervencionista, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain Although the homocoronary retrograde access can be performed using the double catheter technique—the so-called “ping-pong technique”8—facilitating the manipulation of materials through antegrade access, we chose a single arterial access since it is the less invasive option. However, it may interfere with the movement of materials in the antegrade direction (this limitation could improve with the use of 7-Fr catheters). In this case and even though we used a 6-FR guidewire we did not find any trouble moving the materials in the antegrade direction (using fewer Figure 2. A: advancement of a 0.014 in Sion Blue guidewire through collaterals towards the anterior descending artery. B: retrograde recanalization of the anterior descending artery. C: reintroduction of guidewire and Corsair microcatheter inside the XB 4 guide catheter (tip-in technique). D: final angiography after stent implantation. materials also helped). Although feasible, this should be a last resource technique because of the greater risk involved in cases of perforations. In cases of very long total chronic coronary occlusions that require other techniques9 such as the controlled antegrade and retrograde subintimal tracking (CART), double vascular access is preferred because it requires materials of a lower profile. Coronary angioplasty through retrograde access has improved the rate of success of total chronic coronary occlusions.9 Although this technique is conceptually simple, it requires the appropriate tools and experienced heart teams to achieve optimal outcomes.

In-stent restenosis after primary percutaneous coronary intervention: focal versus diffuse pattern. Influence of clinical profile and type of stent