fig1

Figure 1. A: proximal RCA CTO; B: first antegrade approach was attempted but failed (guidewire outside of the vessel, yellow arrow); C: septal collateral was then chosen for retrograde attempt (see magnification in the red square); D: after reverse CART, guidewire externalization and stent implantation on RCA, perforation at level of mid RCA and septal branch were noticed (yellow circles); E: persistent extravasation and pericardial effusion increasing at echo despite covered stent implantation and coil release proximally to septal branch perforation; F: after coil release from retrograde source, no more contrast extravasation and stable pericardial effusion. CTO: chronic total occlusions; CART: controlled antegrade and retrograde tracking; RCA: right coronary artery