First Validation of the "Bite-In" Technique for Retrograde Chronic Total Occlusion Revascularization

Area of Science:

• Interventional Cardiology
• Vascular Surgery

Background:

• Retrograde guidewire (RGW) manipulation and microcatheter (MC) advancement pose significant challenges in chronic total occlusion (CTO) interventions.
• Limited control over RGW deformation necessitates improved strategies for the retrograde approach.

Purpose of the Study:

• To introduce and evaluate the "bite-in" technique as a novel strategy for managing RGW and MC in retrograde CTO procedures.
• To assess the feasibility, safety, and technical success of the bite-in technique.

Main Methods:

• The "bite-in" technique was utilized in 40 patients experiencing difficulties with the conventional "tip-in" approach during retrograde CTO interventions.
• This method involves advancing the RGW into the Guidezilla catheter, followed by MC rotation for spontaneous RGW capture, eliminating active RGW manipulation.
• Data collected included CTO site, procedural duration, and technical success rates.

Main Results:

• The bite-in technique demonstrated 100% technical success in all 40 patients, with no procedural complications.
• Prevalence of limited RGW control and failed retrograde MC advancement was high (88% and 75%, respectively) in cases where bite-in was required.
• The right coronary artery was the most frequent CTO location (60%).

Conclusions:

• The bite-in technique is a safe and feasible method for the retrograde approach to CTO, effectively connecting retrograde and antegrade lumens.
• While short-term performance is acceptable, larger multicenter studies are needed to compare its long-term efficacy against the tip-in approach.