A modified reverse guidewire technique for a Crusade-uncrossable bifurcation lesion
Taku Kasahara1, Kenichi Sakakura1, Shin-Ichi Momomura1
1Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan.
Journal of Cardiology Cases
|January 15, 2020
Summary
A modified reverse guidewire technique successfully navigated severe coronary artery stenosis. This approach enhances crossing ability for complex bifurcation lesions, potentially increasing procedural success rates.
Area of Science:
- Interventional Cardiology
- Vascular Surgery
- Medical Device Technology
Background:
- The reverse guidewire technique is standard for complex bifurcation lesions.
- Severe proximal stenosis can impede guidewire and catheter passage.
Observation:
- A 72-year-old male presented with severe left anterior descending artery stenosis and an angulated diagonal branch.
- Initial attempts using a standard reverse guidewire technique with a double lumen catheter failed to cross the stenosis.
Findings:
- A modified technique advanced only the reversed guidewire across the stenosis.
- The guidewire was then retrogradely maneuvered into the diagonal branch.
- This modification bypasses the need for the entire catheter system to cross the proximal lesion.
Implications:
- This modification may improve success rates for the reverse guidewire technique.
- It could expand the applicability of this technique to more challenging anatomies.
- Simplifying guidewire crossing enhances treatment of complex coronary bifurcations.
