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A patient complained of dyspnea on moderate physical exertion, which resolves at rest.According to the patient, in 2016 he had a MI diagnosed retrospectively according to ECG data (cicatricial changes in the lower wall of the LV). According to ECHO-CG: cardiac chambers were not dilated, EF - 58%. No zones of local contractility abnormalities were detected.

Clinical bloodtest: RBC - 5.3 10 in 12 tbsp. / l; HGB - 155 g / l;  MCV – 84.2  cubic meters; PLT - 213 10 in 9 st. / l; MPV –9.2 cubic meters; Leukocytes – 8.2 10 in 9 tbsp. / l; Segmented neutrophils,% -64.2%; Lymphocytes,% - 27.2%; Monocytes,% - 6.6%; Eosinophils,% - 1.1%;Basophils,% - 0.9%; Erythrocyte sedimentation rate - 4 mm / h;Biochemicalblood test: Potassium – 3.91 mmol / l; Glucose – 6.26 mmol / L; GFR (MDRD) M - 77ml / min / 1.73m2; Serum creatinine – 95.9 μmol / l.

Type of coronaryblood supply: right.LM: with unevencontours.LAD: has unevencontours, without hemodynamically significant stenoses.CxA: has unevencontours, without hemodynamically significant stenoses.RCA: with unevencontours, occluded in the middle segment, the post-occlusion section is wellfilled along intra- and intersystem collaterals.

A guidingcatheter is placed in the ostium of the LM. Thesecond guiding catheter was placed in the ostium of RCA.  Numerousattempts of antegrade recanalization using guidewires of different stiffnesswere unsuccessful.  It was decided toperform retrograde recanalization of the RCA. A coronary guidewire supported bya Corsair microcatheter was inserted through the septal branch into the distalthird of the PDA. Escalation to a stiffer guidewire was performed.Subintimal retrograde guidewire was inserted into the proximal segment of theACL and the guidewire was externalized into the guide catheter using ReverseCART technique. The tip-in technique was used to recanalize the anteromedicalCorsair microcatheter along the retrograde conductor. The microcatheter wassuccessfully inserted into the distal segment of the RCA. The antegradeguidewire was replaced. The microcatheter was removed. Balloon catheter 2.0x30mm was used for predilation in the proximal and middle segments of the RCA at14 atm.  A satisfactory blood flow wasobtained in the artery. Consecutive DES 2.75x44mm, DES 2.75x44mm, DES 3.5x39mmstents were implanted in the distal, middle and proximal segments of the RCA,at pressures up to 16 atm. At control angiography, the blood flow along theTIMI III artery. The operation was completed.

Contralateral imaging is mandatory in the absence of intrasystemic collaterals. Antegrade injections of contrast agent during recanalization of CA, most often are uninformative and can create problems. The availability of instruments and the ability of the team to use retrograde recanalization techniques, is an important prerequisite, for the interventional laboratory. Bilateral transradial access 6 Fr, in most cases allows to carry out retrograde recanalization of CA comfortably.