A Novel Technique of "Drag-Drill" for Retrograde Chronic Total Occlusion Revascularization in Heavily Calcified Tortuous Lesions: A Case Report.

We report the case of a 73-year-old male with a history of recurrent coronary interventions who presented with progressive angina and was diagnosed with a chronic total occlusion (CTO) of a heavily calcified and tortuous right coronary artery (RCA). Standard antegrade and retrograde techniques were attempted but failed due to the complexity of the lesion. A novel "Drag-Drill" technique was employed, utilizing a retrogradely externalized RG3 guidewire as a rotational atherectomy wire, enabling successful rotational atherectomy and percutaneous coronary intervention (PCI). The technique involved protecting the distal tip of the guidewire with a retrograde microcatheter to maintain stability and prevent vascular injury. At the 3-month follow-up, the patient remained angina-free. This case highlights the "Drag-Drill" strategy as an innovative and effective approach for the treatment of severely calcified and tortuous CTO lesions, underscoring the importance of tailored techniques in complex cases.