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In percutaneous coronary intervention (PCI) with a retrograde approach, successful guide wire passage through the collateral channels is indispensable. However, success of the procedure depends on the quality of collateral channels, and vascular tortuosity is one of the most common obstacles for successful guidewire passage. Case Presentation: Herein, we present a case of PCI with retrograde approach for chronic total occlusion at the ostium of the left anterior descending coronary artery. A highly tortuous morphology of the right posterior descending artery (PDA) and septal channels bifurcating from the right PDA with marked angulations were recognized in angiographic images from multiple directions. We could advance a guidewire to the optimal route of the septal collateral channel with guidance provided by these images and successfully completed all PCI procedures. Conclusions: To pass a guidewire through collateral arteries in PCI with a retrograde approach, careful inspection of angiographic images for thoroughly understanding the optimal route through the collateral vasculature is of great significance.

A pitfall in selecting promising septal collateral channels in percutaneous coronary intervention with a retrograde approach