Sequential Dual Guide Catheter Technique for Chronic Total Occlusion Interventions in Patients With Prior Coronary Artery Bypass Graft Surgery.

Triple arterial access is sometimes necessary for complete visualization of the collateral circulation and distal vessel anatomy, and to facilitate the retrograde approach in complex chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass surgery (CABG) and multiple sources of collaterals. We present two CTO PCI cases in prior CABG patients with complex occlusions supplied by multiple sources of collaterals for which a "sequential dual guide technique" was used, reducing the number of necessary arterial access points from three to two.