Table 1.

Complications of Retrograde CTO PCI: Prevention and Bail out.⁵

Complications	Prevention	Bail out
•Coronary perforation	•Verification of guidewire position before microcatheter advancement	•Coil and fat embolization for distal vessel & CC perforation •Covered stent/prolonged balloon inflation for largeperforation •±Pericardiocentesis
•CC perforation/rupture	•Careful selection of CC •Preference septals	•Prolonged balloon inflation •Heparin neutralization •Embolization if necessary •Immediate hemostasis in epicardial CC perforation, careful observation in case of septal (fenestration or embolization if chest pain)
•Donor vessel trouble (thrombus, dissection)	•Retrograde guide position & waveform monitoring •Adequate flushing •ACT (300–350 s)	•Stenting of dissection •±Hemodynamic support •Thrombus aspiration
•MI	•Avoid large SB dissection •ACT (300–350 s)	•Low threshold for PCI •±Hemodynamic support
•CIN	•Adequate pre & post PCI hydration •Minimum contrast use	•Support care
•Equipment loss or entrapment	•Proper lesion preparation before device delivery	•Retrieval with snares •To leave in situ & cover with stenting
•Radiation skin injury	•Use of X-ray in need only •Radiation reducing x-ray systems	•Support care •Follow-up several weeks after PCI
•Stroke	•ACT (300–350 s) •Minimum catheter manipulation	•±Endovascular treatment •Immediate CT

CC, collateral channel; ACT, activated clotting time; MI, myocardial infarction; CIN, contrast induced nephropathy; SB, side branch; PCI, percutaneous coronary intervention; CT, computed tomography.