# Case Report: A case of successful recanalization of chronic total occlusion using a left brachial artery approach for intra-aortic balloon pump support and a right brachial artery–right radial artery approach for bilateral angiography

## TL;DR

A patient with blocked coronary and leg arteries was successfully treated using alternative artery access methods for heart procedures.

## Contribution

Demonstrates a novel vascular access strategy for CTO recanalization in patients with lower limb artery occlusion.

## Key findings

- Successful IABP insertion via the left brachial artery was achieved.
- Bilateral coronary angiography was performed using the right radial and right brachial arteries.
- The alternative approach enabled effective CTO recanalization in a patient with limited lower limb access.

## Abstract

Chronic total occlusion (CTO) of the coronary arteries can be managed using a retrograde strategy guided by bilateral angiography, substantially improving the likelihood of successful recanalization. To enhance procedural safety, hemodynamic support—such as intra-aortic balloon pump (IABP) counterpulsation—is frequently employed. Nevertheless, in patients presenting with concurrent femoral artery occlusion in the lower limbs, conventional access via the femoral route becomes unfeasible, significantly complicating intervention efforts. This report describes a case involving a patient with CTO alongside complete bilateral external iliac artery occlusion. In this instance, we achieved successful IABP insertion through the left brachial artery and performed bilateral coronary imaging via the right radial and right brachial arteries, ultimately accomplishing effective lesion recanalization. This alternative approach demonstrates a practical solution for individuals with CTO who have limited vascular access in the lower extremities.