Complete Revascularization of Multiple Coronary CTOs in a Single Session Using Hydrodynamic Contrast Recanalization

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) presents significant technical challenges compared to non-CTO PCI.
• Novel techniques, including hydrodynamic contrast recanalization (HDR), are improving success rates and reducing complications in CTO PCI.
• This case report focuses on a complex scenario involving multiple CTOs in an elderly patient with significant comorbidities.

Purpose of the Study:

• To present a case of successful single-session PCI of multiple CTOs using the HDR technique.
• To highlight the feasibility and advantages of HDR for complete revascularization in high-risk patients.
• To demonstrate the potential of HDR as an adjunct to conventional CTO PCI strategies.

Main Methods:

• A 71-year-old female patient with severe comorbidities and multi-vessel CTO underwent coronary angiography.
• Given high surgical risk, percutaneous revascularization was pursued using the HDR technique for CTO crossing.
• Successful PCI with drug-eluting stent placement was performed in the LAD, LCX, and RCA in a single session.

Main Results:

• The patient underwent successful HDR-facilitated PCI of all three major coronary arteries in a single session.
• Restoration of TIMI 3 flow was achieved in all treated vessels.
• The patient experienced marked symptomatic improvement post-procedure.

Conclusions:

• Hydrodynamic contrast recanalization (HDR) is an effective novel technique for crossing CTOs, offering faster recanalization and side branch preservation.
• Single-session complete revascularization of multiple CTOs using HDR in an elderly, high-risk patient was successfully achieved.
• HDR shows promise as a safe and efficient adjunct to conventional CTO PCI, improving clinical outcomes and minimizing procedural risks.