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Published on: April 17, 2021
Application of a snare technique in retrograde chronic total occlusion percutaneous coronary intervention - a step by
Hsiu-Yu Fang1, Wei-Chieh Lee, Chih-Yuan Fang
1Division of Cardiology, Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Insights
The "snare technique" is a safe and effective method for retrograde percutaneous coronary intervention (PCI) in chronic total occlusion (CTO), particularly for complex ostial lesions. It reduces contrast use and improves guidewire externalization without increasing complications.
Area of Science:
- Interventional Cardiology
- Cardiovascular Interventions
- Vascular Surgery
Background:
- Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is increasingly utilized.
- CTO lesions originating from the ostium present unique challenges for PCI.
- Retrograde approaches are often necessary for complex CTOs.
Purpose of the Study:
- To describe and evaluate the efficacy of the "snare technique" in retrograde CTO PCI.
- To assess the safety and feasibility of this specific technique for challenging CTO cases.
Main Methods:
- Retrospective analysis of 371 retrograde CTO PCIs performed between 2006 and 2015.
- The "snare technique" was identified and analyzed in 10 patients within the cohort.
- Comparison of baseline characteristics, procedural outcomes, and complications between patients who underwent the "snare technique" and those who did not.
Main Results:
- The "snare technique" was used in 10 out of 371 retrograde CTO PCI cases.
- Patients in the "snare technique" group had fewer side branches at occlusion (30.0% vs 71.2%) and higher externalization rates (90% vs 25.5%).
- Lower contrast volume was used in the "snare technique" group (285.0 mL vs 379.2 mL), with no significant difference in major complications or success rates.
Conclusions:
- The "snare technique" is a safe and feasible adjunct for retrograde CTO PCI.
- It is particularly beneficial for complex cases, including ostial occlusions and difficult coronary anatomy.
- This technique may facilitate guidewire externalization and reduce contrast utilization in challenging CTO interventions.
Abstract:
Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has recently become popular among interventional cardiologists. CTO originating from the ostium has been one of the most difficult CTO lesions to treat with PCI for a number of reasons. Our aim was to illustrate a specific technique during retrograde CTO PCI referred to as the "snare technique."We retrospectively examined the use of "snare technique" among 371 consecutive retrograde CTO PCIs performed at our institution between 2006 and 2015."Snare technique" was used in 10 patients among the 371 retrograde CTO PCIs. The baseline clinical and angiographic characteristics of patients with or without "snare technique" were similar. The "snare technique" group had significantly fewer side branches at occlusion (30.0% vs 71.2%, P = 0.01) and a higher incidence of externalization (90% vs 25.5%, P < 0.001). The contrast volume was significantly lower in the "snare technique" group (285.0 ± 68.5 vs 379.2 ± 144.0, P = 0.04). The incidence of major complications, retrograde success, or final success did not differ between the groups.The "snare technique" is safe and feasible in retrograde CTO PCI, especially in cases of difficult coronary engagement in cases such as ostial occlusion, challenging coronary anatomy, or retrograde guidewire cannot get in antegrade guiding catheter.
