A Novel Technique of “Drag‐Drill” for Retrograde Chronic Total Occlusion Revascularization in Heavily Calcified Tortuous Lesions: A Case Report

ABSTRACT We report the case of a 73‐year‐old male with a history of recurrent coronary interventions who presented with progressive angina and was diagnosed with a chronic total occlusion (CTO) of a heavily calcified and tortuous right coronary artery (RCA). Standard antegrade and retrograde techniques were attempted but failed due to the complexity of the lesion. A novel “Drag‐Drill” technique was employed, utilizing a retrogradely externalized RG3 guidewire as a rotational atherectomy wire, enabling successful rotational atherectomy and percutaneous coronary intervention (PCI). The technique involved protecting the distal tip of the guidewire with a retrograde microcatheter to maintain stability and prevent vascular injury. At the 3‐month follow‐up, the patient remained angina‐free. This case highlights the “Drag‐Drill” strategy as an innovative and effective approach for the treatment of severely calcified and tortuous CTO lesions, underscoring the importance of tailored techniques in complex cases.