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The Wire Rendezvous and Chasing Wire Technique in the Bidirectional Approach for the Percutaneous Coronary Intervention for Chronic Total Occlusion with a Single Guiding Catheter.

ABSTRACT: A bidirectional approach for percutaneous coronary intervention for chronic total occlusion (CTO-PCI) using ipsilateral collaterals with a single guiding catheter limits procedural choices. The CTO of the left circumflex artery with ipsilateral collateral artery was treated by the bidirectional approach using a single guiding catheter. While the retrograde wire directly crossed the CTO lesion, the microcatheter could not pass the CTO lesion despite the conventional strategies. Therefore, we performed the wire rendezvous and chasing wire techniques. The wire rendezvous technique enables deeper retrograde guidewire progression, and the antegrade microcatheter can reach the CTO entry. The chasing wire technique enables the antegrade guidewire to pass the route made by the retrograde guidewire. These techniques might offer a possible solution for bidirectional CTO-PCI using a single guiding catheter. However, this technique should be considered as a last resort because of the risk of rapid reocclusion.

SUBMITTER: Nakabayashi K

PROVIDER: S-EPMC6232790 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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The Wire Rendezvous and Chasing Wire Technique in the Bidirectional Approach for the Percutaneous Coronary Intervention for Chronic Total Occlusion with a Single Guiding Catheter.

Nakabayashi Keisuke K Sunaga Daisuke D Kaneko Nobuhito N Matsui Akihiro A Tanaka Kazuhiko K Ando Hiroshi H Shimizu Minoru M

Case reports in cardiology 20181030

A bidirectional approach for percutaneous coronary intervention for chronic total occlusion (CTO-PCI) using ipsilateral collaterals with a single guiding catheter limits procedural choices. The CTO of the left circumflex artery with ipsilateral collateral artery was treated by the bidirectional approach using a single guiding catheter. While the retrograde wire directly crossed the CTO lesion, the microcatheter could not pass the CTO lesion despite the conventional strategies. Therefore, we perf ...[more]

PMID: 30510810

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Project description:IntroductionPercutaneous coronary intervention (PCI) of chronic total occlusion (CTO) remains a challenge. The reasons being that these procedures may be lengthy and complex, with elevated radiation exposure, increased contrast load, lower procedural success rate, and a higher risk of complication when compared with non-CTO elective PCI.Clarifying the long-term clinical outcomes of CTO-PCI is very important to justify potential investments in training and technology. However, there is a paucity of data from Indian subcontinent. Hence we decided to report the outcomes from a real-life cohort of consecutive patients undergoing elective PCI for CTO at our institution.Materials and methodsSingle-center, prospective observational study. A total of 339 consecutive patients who underwent elective PCI for chronic total occlusion between Feb 2016 to Feb 2018 were included in the study. Procedural techniques, complications and clinical outcomes {all-cause death, cardiac death, major adverse cardiac events (MACE) and target vessel revascularization (TVR)} were assessed in our study population.Results339 patients were prospectively followed up for a duration that ranged from 3 months to 36 months, with a median follow up of 24 months. Overall procedural success was achieved in 85.5% (n = 290) cases. No significant differences were noted in In-Hospital adverse events (5.5% vs. 4.1%; p 0.998). MACE rate was significantly higher in unsuccessful CTO group (36.7% vs. 8.9%, p 0.001) and was predominantly driven by Ischemia Driven (ID) - Revascularization (16.3% vs. 3.1%, p < 0.001). Cardiac death and All-cause death was not significantly different between the groups. Residual angina (26.5% vs. 10%, p 0.003) and residual dyspnoea (34.7% vs. 12.4%, p < 0.001) were significantly worse in unsuccessful CTO group.ConclusionsProcedural success in the present drug-eluting stent (DES) era is more than 80% and newer techniques and hardwares have improved the procedural success rate, especially in younger age groups. MACE rates were significantly higher in the unsuccessful CTO group. Residual angina and dyspnoea were significantly worse in the unsuccessful CTO group.

Project description:Our aim was to evaluate the feasibility and safety of routine transradial approach (TRA) percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions using the sheathless technique with standard guiding catheters.Transradial approach PCI was applied for CTO lesions. A major limitation of TRA CTO PCI is the inability to use large guiding catheters because of the relatively small size of the radial artery. Therefore, the sheathless technique for TRA PCI has been recently developed. However, reports on TRA CTO PCI using the sheathless technique are still lacking.Sixty-eight patients with CTO lesions were enrolled for TRA PCI using the sheathless technique with standard guiding catheters. The baseline characteristics, coronary angiographic characteristics and major procedure or access site related complications were compared between procedure success and procedure failure group to determine the predictors of success in sheathless CTO PCI. In-hospital and 30-day clinical outcomes were also evaluated in this study. Routine assessments of radial artery occlusion via Doppler ultrasound and pulse oximeter were recorded during one-year clinical follow-up.The mean duration of CTO by history was 31.8 ± 42.3 months. The 7 Fr standard guiding catheter was used with the sheathless technique in 91.2%, and bilateral sheathless approach in 42.6% of the study patients. The procedure-related complications included coronary perforation needing covered stent deployment (2.9%), cardiac tamponade (2.9%), collateral perforation needing coil deployment (4.4%), and contrast induced nephropathy (2.9%). Only 2 patients (2.9%) experienced forearm ecchymosis at the radial artery access sites. In-hospital mortality and 30-day all-cause mortality were 2.9%, and 30-day MACEs were 1.5%. The rate of radial artery occlusion during one-year clinical follow-up was only 3.0%.It is feasible and safe to routinely use the sheathless technique with standard guiding catheters for TRA CTO PCI, with a low incidence of procedure-related complications and long-term radial artery occlusion.

Dataset Information

The Wire Rendezvous and Chasing Wire Technique in the Bidirectional Approach for the Percutaneous Coronary Intervention for Chronic Total Occlusion with a Single Guiding Catheter.

Publications

The Wire Rendezvous and Chasing Wire Technique in the Bidirectional Approach for the Percutaneous Coronary Intervention for Chronic Total Occlusion with a Single Guiding Catheter.

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