0000000000519424
AUTHOR
Rocco Giunta
Dual guidewire balloon antegrade fenestration and re‐entrytechnique for coronary chronic total occlusions percutaneouscoronary interventions
Objectives:To describe the experience of coronary chronic total occlusions (CTOs)percutaneous coronary interventions (PCI) using antegrade fenestration and re‐entry(AFR) technique with a dedicated dual guidewire balloon (DGB).Background:Antegrade dissection and re‐entry (ADR) techniques has beenemphasized in recent worldwide CTO consensus documents. We investigated thefeasibility and safety of DGB as a dedicated device to perform guidewire‐based AFR.Methods and Results:Fourteen consecutive patients with complex CTO (J‐CTOscore: 3.1 ± 0.9) underwent DGB‐AFR in the years 2020–2021. DGB‐AFR consists inadvancing the DGB over a guidewire that reached the vessel distal to the CTO in anextra plaqu…
Channel Tracking Guidewire and Technique for Retrograde Approach
Evaluation of the collateral circulation is critical for determining the feasibility of the retrograde approach. When assessing collateral channels it is of paramount importance to take time and review the previous angiogram carefully, for multiple potential collateral pathways, as the predominant collateral may change over time prior to the procedure. Careful review of collaterals prior to the procedure can reduce contrast and radiation dose as well as the duration of the procedure.Retrograde access to the distal vessel can be achieved via septal collaterals, epicardial collaterals (atrial channel), or (patent or occluded) coronary bypass grafts. Generally septals are used more often 65–70…
When, why, and how to perform wire-based antegrade dissection and reentry technique
Antegrade dissection and reentry (ADR) refers to an attempt to cross a coronary chronic total occlusion (CTO) lesion through wire and/or equipment passage in the subintimal space followed by reentry to the distal true lumen. From the original subintimal tracking and reentry (STAR) technique description by Colombo in 2005, refinement of the technique, improved characteristics of the microcatheters and wires, and better understanding of subadventitial vessel trauma have led to higher success rates, lower complications rates, and improved long-term outcomes. In this chapter, we discuss the technique, its outcomes, and limitations.