Background

Percutaneous Coronary Interventions (PCI) of chronic total occlusions (CTOs) represent one of the most complex procedure in the whole spectrum of PCI. In the last years the success rate of CTO-PCI has improved because of the evolution in materials and in CTO-techniques. For most CTO operators, the choice of the vascular access has been driven by the desire to achieve a high success-rate. The trans-femoral access allows the use of larger caliber guide catheters with increased passive support and may help to achieve a better procedural success. Recently, the use of bi-radial approach has gained popularity, supported by evidence of non-inferiority versus the bifemoral/radial-femoral approach. At present, very limited data are available concerning the use of trans-ulnar access for this complex setting of PCI.