Retrograde Balloon-Assisted Screening Prevents Guidewire Prolapse During Acute-Angle Distal Cap Puncture in RCA CTO
Takeshi Niizeki1, Tadateru Iwayama1, Toshiki Sasaki1
1Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan.
Insights
Retrograde balloon-assisted screening is a novel technique for challenging chronic total occlusion (CTO) percutaneous coronary intervention. This method prevents guidewire prolapse during retrograde approaches with difficult exit angles.
Area of Science:
- Interventional Cardiology
- Cardiovascular Interventions
Background:
- Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) presents unique challenges.
- Retrograde approaches are often employed for CTO PCI, but guidewire prolapse can occur.
- Unfavorable retrograde exit angles exacerbate the risk of guidewire prolapse.
Objective:
To describe the practical application of retrograde balloon-assisted screening as a bailout strategy for guidewire prolapse associated with an unfavorable retrograde exit angle in chronic total occlusion (CTO) percutaneous coronary intervention.
Key Steps:
A 70-year-old man with a right coronary artery CTO underwent percutaneous coronary intervention using a retrograde approach via a septal collateral channel. Retrograde wiring was unsuccessful due to an extremely steep exit angle despite a dual-lumen microcatheter support. An over-the-wire balloon was advanced retrogradely and inflated just distal to the CTO exit bifurcation. The balloon prevented guidewire prolapse and enabled controlled retrograde wiring into the CTO segment. Reverse controlled antegrade and retrograde tracking enabled successful recanalization.
Potential Pitfalls:
Predilation of the septal collateral channel with a small-diameter balloon may be required to facilitate device delivery.
Take-Home Messages:
Retrograde balloon-assisted screening is a useful technique to prevent guidewire prolapse in CTO with unfavorable exit angles.
