Successful percutaneous coronary intervention for complex bifurcated lesions with combination of "Reverse wire technique" and "Reverse bent wiring with the crusade catheter" novel wire manipulation technique

Retrograde Balloon Dilation outside the Main Branch Stent to Restore the Occlusion of Side Branch in Chronic Total Occlusion Bifurcation Lesions

Percutaneous coronary intervention (PCI) of a chronic total occlusion (CTO) can be challenging when a bifurcation is present at the distal cap. We described a case of retrograde balloon outside the main branch stent to restore the occlusion of side branch in CTO bifurcation lesion through the jailed wire.

Retrograde parallel wire technique using a dual lumen catheter can be useful for percutaneous coronary intervention with chronic total occlusion

The patient was a 61-year-old male with chronic total occlusion (CTO) of the right coronary artery (RCA). We performed percutaneous coronary intervention (PCI) to RCA-CTO with the bidirectional approach via the left anterior descending artery. In retrograde approach, the first wire entered the false lumen at the segment of severe stenosis of the CTO distal site. We performed parallel wire technique using a dual lumen catheter to avoid branch loss and succeeded to get the proximal true lumen through the second wire. When the first wire enters the false lumen, continued advancement of this wire easily should be avoided as it can collapse the true lumen and make reentry difficult. On top of that, in retrograde approach, it is difficult to perform parallel wire technique without using a dual lumen catheter. This case reveals that retrograde parallel wire technique using a dual lumen catheter is an extremely effective strategy to treat CTO. <Learning objective: The dual lumen catheter is one of the most helpful devices. However, in the field of percutaneous coronary intervention for chronic total occlusion (CTO-PCI), especially retrograde approach, the usage of them has not been established. Retrograde parallel wire technique using a dual lumen catheter may be useful for CTO-PCI.>.

Case report of a novel maneuver to facilitate wire access to the side branch in bifurcation intervention-balloon block and support technique

BACKGROUND

Despite advancements in the devices and techniques used for percutaneous coronary intervention, side branch (SB) wiring remains highly challenging in certain complex bifurcation intervention cases.

METHODS AND RESULTS

In this report, we demonstrate the efficacy and safety of the balloon block and support technique (BBST), which comprises inflation of an appropriately sized balloon 1-2 mm distal from the carina in the distal main branch to facilitate wire access to the SB. Between June 2012 and July 2017, we utilized the BBST as a bail-out strategy for six bifurcation cases with difficult SB wiring. In this report, we present in detail the oldest and the most recent of those cases to illustrate the use of the BBST. As a bail-out strategy, the BBST successfully facilitated SB wiring. No BBST-related complications were observed.

CONCLUSIONS

The BBST may be an efficient and safe method for facilitating SB wiring in complex bifurcation intervention cases and could be used as a bail-out technique.

Dual lumen microcatheters for complex percutaneous coronary interventions

In some bifurcation anatomies side branch wiring can be difficult particularly when side branch is highly angulated. Furthermore a combination of bifurcations and chronic total occlusion can be a real challenge for interventional cardiologists. New devices have been produced to facilitate complex PCI and recently introduced dual lumen microcatheters can be really helpful in these scenarios. All these devices have both a rapid-exchange and an over-the-wire lumen. The rationale for dual lumen microcatheters is to preserve the highest number of side-branches. Nevertheless PCI should always aim to the most complete revascularization and to the lowest rate of side-branch loss. The purpose of this review is to describe current available dual lumen microcatheters, interventional scenarios in which their use may be helpful and basics of their proper use.

A Case of Chronic Total Occlusion of the Left Anterior Descending Artery Successfully Treated with Side Branch Technique Using the Soutenir CV

Patient: Male, 54

Final Diagnosis: Old myocardial infarction

Symptoms: Lower extremity swelling • respiratory distress

Medication: —

Clinical Procedure: Success

Specialty: Cardiology