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Revascularization of Coronary Artery Chronic Total Occlusion by Active Antegrade Reverse Wire Technique
Xiao-Jiao Zhang1,2, Zhan-Xiu Zhang2, Yong Wang1
1Department of Cardiology, The People's Hospital of China Medical University, The People's Hospital of Liaoning Province, Shenyang, China.
Insights
The active antegrade reverse wire technique (ARW) is effective for recanalizing complex coronary artery chronic total occlusions (CTOs). This method improved procedural efficiency with a high success rate and no severe complications in CTO patients.
Area of Science:
- Interventional Cardiology
- Vascular Recanalization
- Coronary Artery Disease
Background:
- Chronic total occlusions (CTOs) present significant challenges in coronary interventions, particularly those with large distal branches.
- The antegrade reverse wire technique (ARW) is a potential strategy when antegrade wire passage is difficult.
Purpose of the Study:
- To evaluate the effectiveness and safety of the active antegrade reverse wire technique (ARW) for vascular recanalization in patients with coronary CTOs.
- To assess the applicability of ARW in complex CTO cases.
Main Methods:
- A retrospective analysis of 301 consecutive CTO patients undergoing antegrade percutaneous coronary intervention (PCI) between December 2015 and December 2019.
- Eleven patients were treated with ARW, with detailed documentation of procedural success, wire types used, and patient characteristics (e.g., J-CTO score, calcification).
Main Results:
- ARW achieved successful recanalization in 10 out of 11 CTO patients (90.9% success rate).
- Successful recanalizations involved various coronary branches, including diagonal (D) to left anterior descending (LAD), septal (S) to LAD, and circumflex (LCX) to obtuse marginal (OM) arteries.
- No loss of side branches or severe procedure-related complications were observed in the 11 patients undergoing ARW.
Conclusions:
- The active antegrade reverse wire technique (ARW) demonstrates high effectiveness and safety for vascular recanalization in complex CTOs.
- ARW can improve procedural efficiency and warrants wider adoption in interventional cardiology practice.
Objectives:
To assess the effectiveness and safety of ARW for vascular recanalization in CTO patients.
Background:
Chronic total occlusion (CTO) of coronary artery accompanied with large branch distal to the occluded segment (<2 mm) is one of the challenges physicians are facing during the coronary intervention. In cases where the antegrade wire passed the occluded segment reaching the branch vessel, but could not access the main vessel through various adjustments, application of active antegrade reverse wire technique (ARW) could be considered. Patients and Methods. A total of 301 consecutive CTO patients who received the antegrade percutaneous coronary intervention (PCI) between December 2015 and December 2019 at our institution were included, of whom 11 were treated with ARW (10 successfully) for vascular recanalization. The applicability and safety of ARW were assessed.
Results:
Among the 301 CTO patients who received antegrade vascular recanalization, 11 were treated with ARW. ARW was successful in 10 patients as follows: from the diagonal branch (D) to anterior descending branch (LAD) in 4 patients; from the septal branch (S) to LAD in 1 patient; from D to S and LAD in 1 patient; from the circumflex branch (LCX) to obtuse marginal branch (OM) in 1 patient; from OM to LCX in 1 patient; from a posterior descending artery (PDA) to the posterior lateral vein (PLV) in 2 patients. Yet, ARW in patient with RCAm CTO failed, while the consequent retrograde PCI succeeded. The mean J-CTO score of the 11 patients was 2.7 ± 0.65, among whom eight were accompanied with calcifications. Sion Black and Fielder XTR reverse wires were used in 9 and 2 patients, respectively. No loss of side branches or severe procedure-related complications occurred in 11 patients.
Conclusion:
Therefore, ARW can improve procedural efficiency and should be popularized for further application.
