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.
Insights
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.
Abstract:
A reverse guidewire technique along with double lumen catheter has become a standard technique for extremely angulated bifurcation lesions. A-72-year-old male underwent coronary angiography, which revealed a severe stenosis of the left anterior descending artery with an extremely angulated diagonal branch. We introduced the Crusade (Kaneka, Osaka, Japan) accompanied with the reversed guidewire to the lesion, but the Crusade with the reversed guidewire could not cross the lesion. We kept the Crusade at the just proximal to the stenosis, and advanced the only reversed guidewire to the lesion. The reversed guidewire successfully crossed the lesion, and then we pulled back the reversed guidewire to lead the reversed guidewire's tip into the diagonal branch retrogradely. In this modified reverse guidewire technique, the Crusade does not need to cross the lesion, but needs to bring the reversed guidewire at the just proximal of the lesion. Because the profile of the reversed guidewire alone is smaller than that of the Crusade accompanied with the reversed guidewire, the reversed guidewire alone has greater chance to cross the severe stenosis. Our modification may increase the success rate of the reverse guidewire technique, and expand the indication of this technique. <Learning objective: In a reverse guidewire technique, if there is a severe stenosis at just proximal of the bifurcation lesion, it may be difficult to cross the double lumen catheter with a reversed guidewire beyond the bifurcation lesion, because the profile of the double lumen catheter accompanied with a reversed guidewire is much larger than the double lumen catheter or the reversed guidewire alone. We modified reverse guidewire technique, which may increase the success rate of the reverse guidewire technique.>.
