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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
PubMed

Insights

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.

Keywords:
chronic total occlusiondissectionpercutaneous coronary interventionreentry technique

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