Related Experiment Video
Updated: Sep 5, 2025
Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
Published on: April 17, 2021
Dual guidewire balloon antegrade fenestration and re-entry technique for coronary chronic total occlusions
Alfredo R Galassi1, Giuseppe Vadalà2, Gabriella Testa2
1Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy.
Insights
The dual guidewire balloon antegrade fenestration and re-entry (AFR) technique offers a reliable approach for treating coronary chronic total occlusions (CTOs). This method achieved an 86% success rate, proving effective even as a bail-out strategy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Interventions
Background:
- Antegrade dissection and re-entry (ADR) techniques are crucial for complex coronary chronic total occlusions (CTOs).
- The study evaluates a novel dual guidewire balloon (DGB) device for guidewire-based antegrade fenestration and re-entry (AFR).
Purpose of the Study:
- To describe the experience and outcomes of using the DGB-AFR technique for percutaneous coronary intervention (PCI) in CTOs.
- To assess the feasibility and safety of the DGB device in performing AFR.
Main Methods:
- Retrospective analysis of 14 consecutive patients with complex CTOs (J-CTO score: 3.1 ± 0.9) treated with DGB-AFR (2020-2021).
- DGB-AFR involves advancing the DGB distally, creating fenestration, and re-entering the true lumen with a guidewire.
- Success rates and the need for rescue ADR were documented.
Main Results:
- DGB-AFR achieved an 86% procedural success rate (12/14 patients), with 71% success using DGB-AFR alone (10/14).
- The technique was used as a bail-out strategy in 71% of cases after failure of other antegrade techniques.
- No DGB-related complications were observed during the procedures.
Conclusions:
- DGB-AFR is a user-friendly and reliable strategy for treating challenging CTO lesions.
- It demonstrates high procedural success and a low rate of adverse events, particularly when used as a bail-out option.
Objectives:
To describe the experience of coronary chronic total occlusions (CTOs) percutaneous coronary interventions (PCI) using antegrade fenestration and re-entry (AFR) technique with a dedicated dual guidewire balloon (DGB).
Background:
Antegrade dissection and re-entry (ADR) techniques has been emphasized in recent worldwide CTO consensus documents. We investigated the feasibility and safety of DGB as a dedicated device to perform guidewire-based AFR.
Methods And Results:
Fourteen consecutive patients with complex CTO (J-CTO score: 3.1 ± 0.9) underwent DGB-AFR in the years 2020-2021. DGB-AFR consists in advancing the DGB over a guidewire that reached the vessel distal to the CTO in an extra plaque fashion, inflating/deflating the DGB to create fenestration between subintimal space and the true lumen and advancing a proximal re-entry guidewire through fenestration in the true lumen. DGB-AFR alone was successful in 10 of 14 (71%) cases, a rescue wire-based ADR was needed in two cases for re-entry into the true lumen with a total success rate in 12 of 14 (86%) cases. Among all DGB-AFR cases, four (28%) were performed as a first-line strategy while the remaining 10 (71%) cases were performed as a bail-out strategy after failure of other antegrade crossings for 30 min of procedural time. No DGB-related complications were observed.
Conclusions:
DGB-AFR is a user-friendly reliable strategy for the treatment of many CTO lesions. It can be used as bail-out after failure of conventional antegrade wiring techniques, achieving high procedural success rate and low occurrence of procedural adverse events.
Related Concept Videos
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:27Coronary Artery Disease V: Interprofessional Care