Imaging behind occluded areas with an iatrogenic perforated balloon: A safe, practical, and simple new method of
Yakup Balaban1, Osman Bektaş2, Adil Bayramoğlu2
1Department of Cardiology, Vm Medical Park Kocaeli Hospital, Başiskele, Kocaeli, Turkey.
Insights
A new technique accurately visualizes guidewire position in coronary total occlusions (CTO) using a perforated balloon. This simple method effectively confirms guidewire placement in the true lumen, preventing complications in acute and chronic cases.
Area of Science:
- Interventional Cardiology
- Medical Device Technology
- Vascular Imaging
Background:
- Coronary total occlusions (CTO) present challenges in guidewire navigation.
- Accurate confirmation of guidewire position within the true lumen is critical for successful intervention.
- Existing methods for guidewire visualization in CTO can be complex or costly.
Purpose of the Study:
- To evaluate the effectiveness and reliability of a novel technique for visualizing guidewire position in patients with acute (ATO) or chronic coronary total occlusion (CTO).
- To determine if the new method can accurately confirm guidewire advancement distal to the lesion within the lumen.
Main Methods:
- A cohort of 63 patients with symptomatic ATO (n=41) or CTO (n=22) was studied.
- A perforated balloon was used to deliver an opaque substance, visualizing the distal lesion and guidewire position.
- This technique was applied when antegrade filling was not demonstrated after guidewire advancement.
Main Results:
- The technique demonstrated 100% success in accurately visualizing the distal lumen.
- No complications were reported during the procedure.
- The method proved effective in confirming guidewire placement within the true lumen.
Conclusions:
- The developed method offers a simpler and more practical approach to true lumen visualization in CTO interventions.
- The technique allows for balloon re-orientation during opaque injection and utilizes standard guidewires.
- This approach is cost-effective, requiring only one balloon per operation.
Objective:
In the present study, we investigated the effectiveness and reliability of a new method that reveals whether guidewire advanced distal to the lesion is in the lumen in patients with acute (ATO) or chronic coronary total occlusion (CTO).
Methods:
Forty-one patients with symptomatic ATO and 22 patients with CTO who were admitted into our catheterization laboratory between January 2016 and March 2017 were included. In patients in whom antegrade filling could not be demonstrated after passing 0.014″ guidewire beyond the total lesion, a 1.25 × 15 mm balloon was punctured with a needle outside the operative field to visualize the total lesion. This perforated balloon was then used to deliver an opaque substance through this hole to visualize the distal part.
Results:
The mean age of our 63 patients was 66 ± 12 years. They had diabetes (57%), hypertension (100%), and a history of PCI (85%). The mean procedural time was 27 ± 6.8 min, and the mean volume of contrast material used was 93.9 ± 24 mL. This technique was 100% successful in accurately demonstrating the distal lumen and preventing complications.
Conclusion:
This new method we developed is much simpler and more useful than other methods for visualization of the true lumen because we can re-orient the balloon at the time of opaque injection and use 190 cm guidewire without additional costs. Additionally, one balloon is sufficient for the operation.
