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Novel and Innovative Hybrid Technique for Type A Aortic Dissection
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Successful Combination of the Slipstream and the Tip Detection-Antegrade Dissection and Re-Entry Techniques for
Masataka Yoshinaga1, Wakaya Fujiwara1, Kenya Nasu2
1Department of Cardiology, Fujita Health University Bantane Hospital, Aichi, Japan.
Objective:
We describe combining the slipstream technique with the tip detection-antegrade dissection and re-entry (TD-ADR) technique using AnteOwl intravascular ultrasound (IVUS) for challenging calcified chronic total occlusion lesions when conventional IVUS-guided approaches fail.
Key Steps:
The procedure included the following steps. 1) Confirm on IVUS that the first guidewire is in the subintimal space. 2) Re-insert the AnteOwl IVUS using the first wire lumen only. 3) Advance a Sasuke double-lumen catheter over the same wire to the IVUS tip. 4) Introduce a second guidewire (Conquest Pro 12 Sharpened Tip with 15° bend) through the second wire port. 5) Perform TD-ADR under IVUS guidance to achieve true lumen re-entry.
Potential Pitfalls:
IVUS cannot directly visualize the advancement of the microcatheter over the true lumen second guidewire, thus careful fluoroscopic guidance is crucial.
Take-Home Messages:
This combined approach provides an effective bailout strategy when microcatheter advancement fails owing to severe calcification. The dual-lumen design, real-time pullback system, and short tip-to-transducer distance of the AnteOwl IVUS optimizes both the slipstream and TD-ADR techniques simultaneously.
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