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HydroDynamic contrast Recanalization (HDR): Description of a new crossing technique for coronary chronic total
Mauro Carlino1, Angelo Nascimbene2, Emmanouil S Brilakis3
1IRCCS San Raffaele Scientific Institute, Milan, Italy.
Insights
HydroDynamic contrast Recanalization (HDR) is a novel technique for crossing chronic total occlusions (CTOs) during percutaneous coronary interventions. This study demonstrates HDR
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Medical Device Technology
Background:
- Intraplaque contrast injection is used in percutaneous coronary interventions (PCI) for chronic total occlusions (CTOs) to visualize anatomy and aid wire crossing.
- The efficacy of intraplaque contrast as a primary crossing tool for CTOs has not been previously established.
Purpose of the Study:
- To introduce and evaluate a new technique, HydroDynamic contrast Recanalization (HDR), for primary wire crossing in coronary CTOs.
- To assess the safety and efficacy of HDR in a first-in-man case series.
Main Methods:
- HDR utilizes synergistic contrast microinjections and polymer-jacketed wires for antegrade CTO crossing.
- A retrospective case series of 43 patients (45 CTOs) with favorable CTO anatomy undergoing PCI with HDR was conducted.
- Primary outcome was procedural success; secondary outcome was procedural complications.
Main Results:
- Procedural success was achieved in 100% of the 45 CTOs treated with HDR.
- The study included patients with complex CTOs, including ambiguous caps, long lesions, and heavy calcification.
- No procedural complications were reported in any of the cases.
Conclusions:
- HydroDynamic contrast Recanalization (HDR) is a safe and effective new technique for primary CTO crossing in selected patients.
- HDR leverages the diagnostic and therapeutic properties of intraplaque contrast injection.
- Further investigation in larger prospective studies is warranted to validate these promising findings.
Background:
Intraplaque delivery of contrast has been utilized during percutaneous coronary interventions (PCI) of chronic total occlusions (CTO) to delineate anatomy and to facilitate wire crossing. Its utility as a tool to accomplish primary crossing of CTOs has not been described or validated.
Aims:
We describe a new technique leveraging the diagnostic and therapeutic roles of intraplaque contrast injection to accomplish primary crossing of CTOs: HydroDynamic contrast Recanalization (HDR).
Methods:
HDR is an antegrade crossing method for coronary CTOs based on the synergistic use of contrast microinjections and polymer jacketed wires. We present a retrospective, first-in-man, case series utilizing HDR for CTO PCI in patients with favorable CTO anatomy (visible proximal segment and identifiable distal target). The primary outcome was procedural success. The secondary outcome was any procedural complications.
Results:
A total of 43 patients with 45 CTOs underwent CTO PCI with HDR. Mean patient age was 64.3 ± 11 years. The mean Japanese CTO and PROGRESS CTO scores were 2.3 ± 0.7 and 1.8 ± 0.7, respectively. CTO complexity was high, with an ambiguous or blunt cap in 34 occlusions (76%); lesion length ≥ 20 mm in 27 occlusions (60%); and moderate/heavy calcification in 36 occlusions (80%). Procedural success using HDR was 100%. There were no complications.
Conclusions:
This study shows the utility of HDR in CTO PCI. HDR appears to be a safe and promising new contrast-based primary crossing technique in selected patients. This strategy warrants further evaluation in larger prospective studies.
