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Simplified Dual-Lumen Catheter-Facilitated Reverse Wire Technique for Markedly Angulated Collateral Channel Entry in
Kaize Wu1, Bingzheng Luo2, Zehan Huang3
1Department of Cardiovascular Medicine, Affiliated Nanhai Hospital, Southern Medical University (People's Hospital of Nanhai District).
Insights
A simplified dual-lumen catheter technique improves success in retrograde coronary total occlusion interventions. This novel method facilitates crossing angulated collateral channels, enhancing percutaneous coronary intervention outcomes.
Area of Science:
- Interventional Cardiology
- Vascular Medicine
Background:
- The retrograde approach is crucial for complex coronary total occlusion (CTO) recanalization.
- Unsuccessful collateral channel crossing is a major cause of retrograde failure in CTO interventions.
Observation:
- Adverse collateral channel morphology, such as large entry angles, hinders successful collateral crossing.
- The reverse wire technique (RWT), often supported by a dual-lumen catheter (DLC), is used for angulated branches.
Findings:
- A novel "simplified dual-lumen catheter-facilitated RWT" is presented for retrograde CTO intervention.
- This technique simplifies RWT by creating the reverse bend within the aorta using a DLC.
- It proves feasible, effective, and safe for navigating markedly angulated collateral channels.
Implications:
- This simplified technique can improve success rates in complex retrograde CTO percutaneous coronary intervention (PCI).
- It offers a valuable new strategy for interventional cardiologists treating challenging CTO lesions.
- Enhanced collateral channel access may lead to better patient outcomes in CTO PCI.
Abstract:
The retrograde approach has significantly improved the success rates in complex coronary total occlusion (CTO) lesions. It has also become the predominant and important strategy in CTO recanalization. However, unsuccessful crossing of the collateral channels is the strongest predictor of retrograde failure, and adverse collateral channel morphology, including large channel entry angle, could reduce the success rate of collateral channel crossing. Reverse wire technique (RWT) was specifically developed for bifurcation lesions with an extremely angulated side branch, and nowadays, this can be achieved by the support of a dual-lumen catheter (DLC). We report a novel method named "simplified dual-lumen catheter-facilitated RWT" to facilitate markedly angulated collateral channel entry in retrograde CTO intervention. This new technique is simplified by making the reverse bend with the support of a DLC in the aorta instead of outside the guiding catheter, which is feasible, effective, and safe for markedly angulated collateral channel entry in retrograde CTO percutaneous coronary intervention (PCI).
