Modified contrast microinjection technique to facilitate chronic total occlusion recanalization

Area of Science:

• Interventional Cardiology
• Vascular Medicine

Background:

• Chronic total occlusion percutaneous coronary intervention (CTO-PCI) success rates remain below 90% in experienced centers.
• Previous large-volume contrast injections into the subintimal space improved recanalization but carried risks.
• A modified microinjection technique using smaller contrast volumes was developed to enhance CTO-PCI safety and efficacy.

Purpose of the Study:

• To evaluate the application, efficacy, and safety of a modified contrast microinjection technique in CTO-PCI.
• To determine if a reduced contrast volume microinjection can facilitate chronic total occlusion recanalization.
• To assess the safety profile of this modified technique in complex CTO cases.

Main Methods:

• Retrospective analysis of patients undergoing CTO-PCI at five tertiary centers.
• The modified microinjection technique was utilized in a subset of patients (4.7%) undergoing CTO-PCI.
• Data collected on lesion characteristics, technique indications, success rates, and procedural complications.

Main Results:

• The modified microinjection technique was used in 59 out of 1,192 CTO-PCI patients.
• Most treated CTOs were in the right coronary artery (79.7%) and were complex, with 35.6% having prior failed PCI attempts.
• The overall success rate was 81.4%, with no procedural complications attributed to the modified microinjection technique.

Conclusions:

• The modified microinjection technique is safe, reproducible, and broadly applicable for CTO-PCI.
• It serves as a valuable adjunctive tool to improve success rates in complex or refractory CTO cases.
• The technique enhances procedural success without compromising patient safety.