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Knuckle Guidewires to Create Dissections in Chronic Total Occlusion Percutaneous Coronary Intervention: Position
Stéphane Rinfret1, Glen A Henry1, Jaikirshan J Khatri2
1Georgia Heart Institute, Northeast Georgia Health System, Gainesville, Georgia, USA.
JACC. Cardiovascular Interventions
|October 30, 2024
Summary
This expert consensus reviews polymer-jacketed wires for chronic total occlusion recanalization. It details dissection techniques, knuckle wire behaviors, and adjunctive methods for safer procedures.
Area of Science:
- Interventional Cardiology
- Medical Device Technology
Background:
- Chronic total occlusion (CTO) recanalization requires specialized dissection and re-entry techniques.
- Extraplaque versus intraplaque stenting approaches have shown comparable outcomes in CTO treatment.
Purpose of the Study:
- To compare the properties of various polymer-jacketed wires used in dissection techniques for CTO recanalization.
- To describe the distinct behaviors of rolling and traveling knuckles in knuckled wires.
- To present adjunctive techniques that enhance the safety of dissection during CTO procedures.
Main Methods:
- Expert consensus review and comparison of polymer-jacketed wires.
- Description of knuckled wire dissection techniques, including rolling and traveling knuckle behaviors.
- Discussion of adjunctive methods for improving procedural safety.
Main Results:
- Different polymer-jacketed wires possess unique properties relevant to dissection techniques.
- Two primary knuckle wire behaviors, rolling and traveling, are identified and explained.
- Several adjunctive techniques can be employed to increase the safety of dissection during CTO recanalization.
Conclusions:
- Selection of appropriate polymer-jacketed wires is crucial for effective dissection in CTO recanalization.
- Understanding knuckle wire behaviors aids in optimizing technique selection.
- Adjunctive strategies are vital for ensuring safe and successful CTO recanalization procedures.
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