The long wire technique--a new technique for steerable balloon catheter dilatation of coronary artery stenoses

A new technique for steerable balloon dilatation is described. In contrast to the usual procedure the stenosis is first crossed by a long wire only. To minimize injury of the vessel wall the wire is equipped with a thickened ball-shaped tip. After the stenosis has been crossed and the wire tip has been advanced far enough, the balloon catheter is inserted over the long wire. If necessary, the balloon catheter can be removed and another one can be inserted without repeat crossing. If an occlusion is caused by the process of dilatation a perfusion catheter can be advanced distal to the occlusion. Perfusion can be performed by help of a simple syringe-tap system because the cross sectional area of this catheter is much larger than a single lumen of the double lumen balloon catheter. This procedure even allows the dilatation of branching stenoses through the same guiding catheter whereas for the usually performed 'kissing balloon' technique two guiding catheters are required. Preliminary experience with 80 patients has shown that crossing of stenoses is facilitated by the new technique because steering of the guide wire and display by contrast medium injections are unhindered. If required, the balloon catheter can be changed for another one without difficulty. In case of occlusion, the lesion can be crossed again without any risk and repeat dilatation or coronary perfusion can be performed.