A Novel 3D Wiring Technique-ZOLUTION Zero Degree OverLap View Universal Three DimensIONal CTO Wiring

We present a novel simple and easy-to-use 3D wiring technique for coronary chronic total occlusions (CTOs) named ZOLUTION-Zero OverLap View Universal Three dimensIONal wiring. ZOLUTION can be used for: (1) Distal cap puncture, (2) CTO body wiring, (3) Retrograde wiring, and (4) Reverse controlled antegrade and retrograde tracking (reverse CART). The four steps of ZOLUTION are: (1) Find the zero-degree overlap fluoroscopic view where the wire shaft and the vessel target are overlapping. (2) Straighten the wire tip by minuscule rotation. (3) Move to a coaxial view 35-70 degrees away (Secondary view) to check that the wire is pointing toward the target (if not, rotate the wire 180 degrees and re-straighten the wire tip in ZOV). (4) In the secondary view puncture forward with the wire toward the target. ZOLUTION does not require formation of a mental map, specific angiographic views of that coronary segment, or fluoroscopic views to be 90-degree apart. It is superior to traditional 3D wiring as it provides a precise angle that is aimed at the target increasing its success rate. We believe ZOLUTION can be universally adopted due to its simplicity and could greatly improve CTO PCI efficiency and safety.