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The effectiveness of super-selective injection with anchor balloon technique for collateral channel assessment
Hiroki Shibutani1, Yuzo Akita1, Yumie Matsui1
1Division of Cardiology, Osaka Saiseikai Izuo Hospital, Osaka, Japan.
Insights
Assessing collateral channels is crucial for treating chronic total coronary occlusion (CTO). A unique super-selective injection technique successfully visualized and utilized a poorly seen atrial circumflex (AC) channel for retrograde CTO intervention.
Area of Science:
- Interventional Cardiology
- Vascular Imaging
Background:
- Percutaneous coronary intervention (PCI) for chronic total coronary occlusion (CTO) often relies on retrograde approaches.
- Effective collateral channel assessment is vital for the success of retrograde CTO procedures.
Observation:
- A case report details a PCI for distal right coronary artery CTO with previously unrecognized collateral circulation.
- Standard angiography failed to visualize all collateral channels, necessitating advanced techniques.
Findings:
- A retrograde approach using the atrial circumflex (AC) channel was successful despite initial visualization challenges.
- A super-selective injection via the proximal AC channel, with antegrade flow obstruction by an anchor balloon, clearly contrasted the distal AC channel.
Implications:
- This case demonstrates a novel technique for assessing poorly visualized collateral channels during retrograde CTO PCI.
- The super-selective injection with anchor balloon method can improve procedural success rates in complex CTO cases.
Abstract:
The careful assessment of collateral channels is important for a retrograde approach for a chronic total coronary occlusion (CTO). This case report describes a percutaneous coronary intervention for CTO of the distal right coronary artery with good collateral circulation. All visible collateral channels failed by the retrograde approach; however, the procedure was successful using the distal atrial circumflex (AC) channel. Although this distal channel was poorly visualized on standard coronary angiography, it was clearly contrasted retrogradely from the CTO exit using a super-selective injection through the proximal AC channel as the antegrade flow was obstructed by the anchor balloon. This case highlights a unique super-selective injection with anchor balloon technique for collateral channel assessment.
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