Double-Guide Catheter "Criss-Cross" Technique and Left Main Bifurcation Rotational Atherectomy

Rotational atherectomy of severely calcified left main (LM) bifurcation lesions can be hazardous, especially when maintaining a protective guidewire in one branch is mandatory.

An 82-year-old man underwent successful percutaneous coronary intervention of a calcified LM bifurcation using a double-guide catheter "criss-cross" technique to reduce periprocedural ischemia and iatrogenic dissection risk associated with a single larger catheter. Rotational atherectomy was safely performed on a tight proximo-ostial circumflex lesion while retaining a protective guidewire in the dissected left anterior descending artery.

Although protective microcatheters have been described, bench studies show consistent microcatheter damage, risk of nonorganic material embolization, and problematic guidewire interactions. Proper positioning of guide catheters modifies wire bias, improving guidewire separation and minimizing burr-wire interactions. Bench testing confirmed this advantage.

The novel double-guide catheter criss-cross technique potentially increases safety in complex calcified proximo-ostial LM lesions by reducing guidewire interactions. Modification of wire bias could extend to all proximo-ostial coronary lesions.