Tratamiento percutáneo de oclusiones coronarias crónicas. A propósito del primer caso abordado en Cuba por vía retrógrada

Introduction: A coronary occlusion is considered chronic when there is no antegrade flow through the obstruction, with estimated or confirmed data for ≥ 3 months. Successful revascularization can improve symptoms and quality of life, restore left ventricular function, and increase long-term survival. Objective: To summarize some studies carried out in Cuba, as well as to show some interventional techniques used. Material and Method: A narrative review was conducted, consulting some of the main online health science databases, with the aim of finding studies on the topic in both international and Cuban populations. Development: There are four strategies for crossing a chronic total occlusion: two antegrade and two retrograde. In both approaches, the lesion can be crossed by passing through the true lumen of the artery (wire scaling) or through the subintimal space (dissection and reentry). There are algorithms that, based on the simultaneous injection of both coronary arteries, allow for a detailed analysis of the anatomy and help determine the best intervention strategy. Patients included in the studies conducted in Cuba show modifiable and non-modifiable risk factors equivalent to other patients with complex coronary artery disease. Conclusions: Currently, there is controversy regarding the clinical benefit of interventional treatment; however, today there are techniques and technology available that facilitate obtaining high success rates in the hands of specialized operators, with few complications.