Hydrodynamic Contrast Recanalization for Crossing Challenging Culprit Occlusions in Acute Myocardial Infarction

Hydrodynamic contrast recanalization (HDR)-a technique adapted from chronic total occlusion percutaneous coronary intervention in which small-volume microcatheter contrast injection creates a low-resistance pathway for wire crossing-can facilitate crossing of challenging culprit occlusions in acute myocardial infarction. We present 3 cases in which conventional wire escalation failed but HDR enabled successful first-attempt crossing, each representing a distinct occlusion acuity: acute thrombotic, subacute organized, and chronic total occlusion. Early use of HDR when crossing proves difficult may reduce crossing time, minimize dissection risk, and reduce thrombus embolization.