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Propofol-Based Lubrication to Overcome Equipment Friction in Chronic Total Occlusion PCI: The Propoglide Technique
Evandro Martins Filho1,2, Marielle Rodrigues Martins3, Ricardo F O Suruagy Motta4
1Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Background:
CTO PCI success depends on consistent equipment performance. Equipment friction (Stingray guidewire lumen fatigue, microcatheter internal lumen friction, and retrograde externalization friction) causes procedural delay and failure. The standard solution is device exchange, which is time-consuming and adds cost. To our knowledge, no published technique addresses CTO-specific equipment friction with an alternative to Rotaglide, which is unavailable in most countries.
Aims:
This report aims to describe and illustrate the Propoglide technique, the use of propofol 1% lipid emulsion as an off-label lubricant to overcome equipment friction in CTO PCI across three clinically distinct scenarios.
Methods:
We describe the Propoglide technique: propofol 1% lipid emulsion (soybean oil carrier) applied as an off-label lubricant across three CTO PCI scenarios: (A) Stingray balloon guidewire lumen, (B) microcatheter inner lumen, and (C) retrograde externalization. Device-specific dead space estimates for common coronary microcatheters guide propofol volume selection. Three illustrative cases demonstrate clinical application.
Results:
Propofol lubrication resolved friction-related failure in all illustrated cases, restoring device function within a single application without device exchange. Propofol volumes ranged from 0.3 to 0.8 mL (3-8 mg), pharmacologically negligible relative to sedation doses. No adverse events were observed in the illustrative cases.
Conclusions:
Propofol 1% emulsion provides practical, safe lubrication for CTO PCI equipment across three clinically distinct friction scenarios, with particular relevance in settings where dedicated lubricants and externalization wires are unavailable. Prospective validation is warranted.
