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Balloon-Assisted Hydrodynamic Contrast Recanalization in Chronic Total Occlusion Intervention
Lingfeng Kong1, Mingqi Zheng1, Ningbo Liu1
1Department of Cardiology, the First Hospital of Hebei Medical University, Shijiazhuang, China.
Insights
Balloon-assisted hydrodynamic contrast recanalization (HDR) offers a novel approach for chronic total occlusion (CTO) interventions. This technique aids guidewire crossing by facilitating localized contrast delivery, potentially improving success rates in complex cases.
Area of Science:
- Interventional Cardiology
- Vascular Interventions
- Medical Imaging
Background:
- Chronic total occlusions (CTOs) present significant challenges in percutaneous coronary intervention.
- Guidewire crossing of the CTO proximal cap is a critical and often difficult step.
Purpose of the Study:
- To evaluate the feasibility and effectiveness of a modified balloon-assisted hydrodynamic contrast recanalization (HDR) technique for CTO intervention.
- To demonstrate a potential technical modification for improving guidewire crossing in challenging CTO cases.
Main Methods:
- A modified balloon-assisted HDR maneuver was employed in a patient with a right coronary artery CTO.
- An over-the-wire balloon was positioned at the proximal cap for localized contrast injection.
- Guidewire crossing into the distal vessel was facilitated by contrast delivery through the balloon lumen.
Main Results:
- The modified balloon-assisted HDR technique successfully facilitated guidewire crossing into the distal vessel.
- Final angiography and intravascular ultrasound confirmed successful recanalization of the CTO.
- The procedure was technically successful in a patient with a J-CTO score of 3.
Conclusions:
- Balloon-assisted HDR represents a potential technical modification for CTO intervention.
- This technique may facilitate localized contrast delivery, aiding guidewire manipulation in selected complex cases.
- Further investigation may be warranted to establish the role of balloon-assisted HDR in CTO treatment.
Image(S):
The images show balloon-assisted hydrodynamic contrast recanalization (HDR) for chronic total occlusion (CTO) intervention.
Case Summary:
A 61-year-old man underwent percutaneous coronary intervention for a right coronary artery CTO with a J-CTO score of 3. After unsuccessful proximal cap penetration using high-penetration guidewires, a modified balloon-assisted HDR maneuver was performed using an over-the-wire balloon positioned at the proximal cap. Contrast injection through the balloon lumen facilitated successful guidewire crossing into the distal vessel. Final angiography and intravascular ultrasound confirmed successful recanalization.
Take-Home Message:
Balloon-assisted HDR may facilitate localized contrast delivery during CTO intervention and represents a potential technical modification in selected cases.