"Rendezvous in coronary" technique with the retrograde approach for chronic total occlusion
Toshiya Muramatsu1, Reiko Tsukahara, Yoshiaki Ito
1Division of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 36-1 Shimosueyoshi, Tsurumi, Yokohama-shi, Kanagawa 230012 Japan. t-mura@tj8.so-net.ne.jp
Insights
A novel "rendezvous in coronary" technique successfully treated a challenging right coronary artery chronic total occlusion (CTO) when standard retrograde approaches failed. This method enabled guidewire crossing and stent placement in a complex CTO case.
Area of Science:
- Interventional Cardiology
- Vascular Surgery
Background:
- Chronic total occlusions (CTOs) of the coronary arteries present significant challenges for percutaneous coronary intervention (PCI).
- Antegrade guidewire crossing is often unsuccessful in complex CTOs, necessitating alternative approaches like retrograde PCI via collateral channels.
Observation:
- In a 77-year-old male with right coronary artery (RCA) CTO, antegrade guidewire passage failed.
- Retrograde PCI via a septal collateral channel was attempted, but guidewire advancement from false to true lumen failed with kissing-wire technique (KWT) and reverse controlled antegrade retrograde tracking (CART).
Findings:
- A modified retrograde approach, termed
- rendezvous in coronary
- technique, was employed.
- This involved advancing an antegrade Conquest Pro guidewire into a retrograde channel dilator catheter after initial KWT and CART failures.
- Successful guidewire crossing was achieved, followed by stent implantation (Cypher stent).
Implications:
- The
- rendezvous in coronary
- technique offers a viable solution for complex CTOs where conventional retrograde methods are unsuccessful.
- This technique expands the armamentarium for interventional cardiologists treating challenging coronary artery occlusions.
- Successful PCI in CTOs improves myocardial perfusion and patient outcomes.
Abstract:
Percutaneous coronary intervention (PCI) was performed for a chronic total occlusion (CTO) of the right coronary artery (RCA) in a 77-year-old male patient. A guidewire could not be passed through the vessel using the antegrade approach, so we tried the retrograde approach via a collateral septal channel. A Fielder FC guidewire (Asahi Intecc Co. Ltd., Aichi, Japan) was passed through the septal channel, and a Corsair catheter (Asahi Intecc) was advanced to the distal side of the CTO in the RCA. However, the guidewire could not be advanced from the false lumen to the true lumen using the kissing-wire technique (KWT) or the reverse controlled antegrade retrograde tracking (CART) technique. Therefore, we retracted the Corsair channel dilator for a #4PD and tried to advance the antegrade Conquest Pro guidewire (Asahi Intecc) from a straight subintimal site into the retrograde channel dilator catheter. After several attempts, the antegrade Conquest guidewire successfully entered the retrograde channel dilator catheter. Subsequently, a Cypher stent (Cordis Corp., Miami Lakes, Florida) was successfully placed. The "rendezvous in coronary" technique was useful for this CTO patient, in whom it was difficult to advance a guidewire into the true lumen by the KWT and CART techniques during the retrograde approach.
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