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Tip detection-antegrade dissection and re-entry method as a bailout technique for coronary perforation in chronic
Shun Yokota1, Nobuaki Igarashi1, Tomofumi Doi1
1Division of Cardiovascular Medicine, Department of Internal Medicine, Japanese Red Cross Kobe Hospital, 1-3-1, Wakinohamakaigandori, Chuo-ku, Kobe 651-0073, Japan.
Insights
A novel technique using intravascular ultrasonography (IVUS) and specialized guidewires successfully treated a complex coronary artery perforation during chronic total occlusion percutaneous coronary intervention (CTO-PCI). This approach enabled simultaneous bleeding control and lesion recanalization.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Medical Device Technology
Background:
- Chronic total occlusion percutaneous coronary intervention (CTO-PCI) carries inherent risks, including vessel perforation.
- Managing complications like perforation during CTO-PCI requires advanced techniques.
Background:
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) increases the risk of complications.
Case Summary:
In CTO-PCI of the right coronary artery, AnteOwl WR intravascular ultrasonography (AO-IVUS; Terumo Corp., Tokyo, Japan) revealed that the antegrade guidewire had entered the subintimal space just beyond the CTO entrance and created a perforation outside the vessel approximately 1 cm distal to it. As the distal part of the AO-IVUS was outside the vessel, its removal worsened the bleeding; hence, it was left in place. Tip detection-antegrade dissection and re-entry techniques were performed using a Conquest Pro 12 Sharpened Tip guidewire (Asahi Intecc Co., Ltd, Aichi, Japan). The Conquest Pro 12 Sharpened Tip guidewire successfully re-entered from the subintimal space into the true lumen immediately before the perforation site. Because the perforation and re-entry sites were adjacent to each other, a covered stent was placed, which enabled simultaneous haemostasis at the perforation site and recanalization of the CTO lesion.
Discussion:
Although AnteOwl WR intravascular ultrasonography (AO-IVUS)-based tip detection-antegrade dissection and re-entry is an advanced technique, we believe that it is valuable for various PCI cases.
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