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Power Flush, a Novel Bailout Technique for Stumpless Aorto-Ostial CTOs: A Case-Based Approach
Roberto Garbo1, Manfredi Arioti2, Massimo Leoncini2
1Maria Pia Hospital - GVM, Strada Comunale di Mongreno 180, 10132 Turin, TO, Italy.
Insights
Power Flush and Nick And Flush are novel bailout techniques for aorto-ostial coronary artery chronic total occlusions. These methods effectively overcome retrograde wire failure, enabling successful vessel recanalization without complications.
Area of Science:
- Interventional Cardiology
- Vascular Surgery
Background:
- Aorto-ostial coronary artery chronic total occlusions (CTO) present unique challenges including poor guiding catheter support and resistant plaque composition (high collagen, calcium).
- These characteristics impede standard recanalization techniques, often leading to retrograde wire failure during procedures.
Observation:
- The Power Flush technique involves forceful contrast injection through a guiding catheter against the aortic wall near the coronary ostium.
- A variant, Nick And Flush, includes preliminary aortic wall nicking with a penetrative wire before the Power Flush injection.
- Three cases of aorto-ostial CTO were treated, with two utilizing Power Flush and one using Nick And Flush.
Findings:
- Both Power Flush and Nick And Flush techniques were successfully employed in all three presented cases.
- No procedural complications were reported in any of the treated patients.
- These techniques proved effective in achieving retrograde access to the aorta, overcoming initial wire failure.
Implications:
- Power Flush and Nick And Flush offer viable bailout solutions for complex aorto-ostial CTOs where conventional methods fail.
- These techniques enhance the interventional cardiologist's toolkit for managing challenging coronary artery lesions.
- Successful application suggests potential for improved outcomes in patients with difficult-to-treat CTOs.
Background:
Aorto-ostial coronary artery flush chronic total occlusions are a challenging subset of lesion with peculiar characteristic: the near complete lack of guiding catheter support, the presence of a thicker layer of muscular fibers and a greater collagen and calcium content, responsible for balloon dilatation's resistance and greater recoil tendency. We introduce a novel bailout technique to overcome retrograde wire failure in accessing aorta, a variation of the Carlino technique which we named Power Flush.
Materials And Methods:
Power Flush consists in a forceful injection of contrast dye directly through the guiding catheter positioned against the aortic wall in correspondence to the coronary ostium location, to gain access to the extra-plaque space and proceed with the vessel's recanalization. In one case we used a further iteration named Nick And Flush, in which a preliminary nicking of the aortic wall with a penetrative wire was done before the Power Flush.
Results:
We hereby present three cases of aorto-ostial right coronary artery flush chronic total occlusions. In two of them we utilized the Power Flush technique, in one case we employed its variant Nick And Flush. We were successful in all cases and no complication occurred.
Conclusions:
In this kind of lesions Power Flush and Nick And Flush are effective bailout techniques to overcome retrograde wire failure to reach aorta.
