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Simple Techniques for Antegrade Guiding Catheter Engagement after Retrograde CTO Crossing.

ABSTRACT: Interventional treatment of chronic total occlusions (CTOs) is nowadays counting on a wide span of procedural possibilities, and retrograde approaches are becoming more and more frequent as they warrant high success rates at the cost of a slightly higher incidence of donor vessel damage. Retrograde lesion crossing needs to be followed by procedural conversion to an antegrade approach to dilate and stent the lesion, and new techniques are being proposed to address this issue and achieve a safer recanalization of the vessel. In this context, we propose novel and simple techniques to antegrade guiding catheter engagement by the retrograde wire, enhancing the chances for procedural success.

SUBMITTER: Leibundgut G

PROVIDER: S-EPMC7271058 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Simple Techniques for Antegrade Guiding Catheter Engagement after Retrograde CTO Crossing.

Leibundgut Gregor G Quagliana Angelo A Riede Florian F Büttner Heinz-Joachim HJ

Journal of interventional cardiology 20200523

Interventional treatment of chronic total occlusions (CTOs) is nowadays counting on a wide span of procedural possibilities, and retrograde approaches are becoming more and more frequent as they warrant high success rates at the cost of a slightly higher incidence of donor vessel damage. Retrograde lesion crossing needs to be followed by procedural conversion to an antegrade approach to dilate and stent the lesion, and new techniques are being proposed to address this issue and achieve a safer r ...[more]

PMID: 32547329

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Project description:BackgroundIn recent years, the retrograde approach has become a common practice in the treatment of chronic total occlusion (CTO) of coronary ostium which is arising abnormally and has an ambiguous proximal cap. In this case report, we report a case of retrograde percutaneous coronary intervention (PCI) done successfully on an abnormally originating artery which was guideliner assisted. Case Presentation. A 65-year-old gentleman with a history of hypertension, diabetes, and PCI presented to us with angina. Physical examination, electrocardiography (ECG), and echocardiography were done. Coronary angiography (CAG) revealed a normal left anterior descending artery (LAD), an anomalous circumflex (CX) artery arising from the right cusp. The abnormal CX had an implanted stent from which the abnormal right coronary artery (RCA) was arising and had a CTO. It also revealed the retrograde filling of distal RCA through grade 2 Werner collateral channels (CCs) from the LAD, a long CTO segment with a distal cap at the bifurcation. PCI of an RCA-CTO was scheduled utilizing a primary retrograde strategy, since antegrade ostium was abnormal in origin, and the patient was previously stented across the origin. The retrograde wire was externalized, and the procedure was completed with 3 overlapping drug-eluting stents (DESs). We used a guideliner which also assisted in the capture of retrograde corsair during the retrograde procedure of CTO [assisted reverse controlled antegrade and retrograde tracking (CART)]. These measures helped us to complete the CTO intervention successfully.ConclusionThe antegrade crossing is the most common approach to CTOs. However, it is sometimes difficult to penetrate the proximal hard ambiguous cap with guidewires, especially in the case of CTOs of anomalous coronary arteries because of a lack of support. Herein, we describe an iteration of reverse CART technique using a guide extensor catheter to facilitate externalizing the retrograde wire from false to true lumen.

Project description:BackgroundRobot-assisted radical prostatectomy (RARP) with extended lymphadenectomy (ePLND) is the gold standard for surgical treatment of prostate cancer (PCa). Recently, the en-bloc ePLND has been proposed but no studies reported on the standardization of the technique. The aim of the study is to describe different standardized en-bloc ePLND, the antegrade and the retrograde ePLND, and to compare their surgical and oncological outcomes.Materials & methodsFrom January 2018 to September 2019, all patients subjected to RARP plus ePLND by one single surgeon were enrolled. ePLND was performed in a retrograde fashion by starting laterally to the medial umbilical ligament from the internal inguinal ring proceeding towards the ureter, or in an antegrade way by starting from the ureter at its crossing with the common iliac artery and proceeding towards the femoral canal. Patients' demographic data, clinical and surgical data were collected. Each en-bloc ePLND was categorized as "efficient" or "inefficient" by the operator, as surrogate of surgeon's satisfaction.ResultsAntegrade and retrograde ePLND were performed in 41/105 (group A) and 64/105 (group R) patients, respectively. The two groups (A vs R) had similar median (IQR) number of lymph nodes retrieved [20 (16.25-31.5) vs 19 (15-26.25); p = 0.18], ePLND time [33.5 (29.5-38.5) min vs 33.5 (26.5-37.5) min; p = 0.4] and post-operative complications [8/41 (19.5%) vs 9/64 (14.1%); p = 0.61]. In group A, 3/41 (7.3%) clinically significant lymphoceles were reported, while 1/64 (1.6%) in group R (p = 0.3). 33/41 (80.5%) and 28/64 (44%) procedures were scored as efficient 59 in group A and R, respectively (p = 0.01). On multivariate regression, only BMI (B = 0.93; 95% CI 0.29-1.56; p = 0.005) was associated with a longer ePLND time.ConclusionsThe study indicates that antegrade and retrograde en-bloc extended pelvic lymph node dissection (ePLND) have comparable surgical and oncologic outcomes, supporting the importance of standardizing the procedure rather than focusing on the direction. Although both techniques aligned with current evidence regarding lymph node invasion and complications, the antegrade approach was subjectively perceived as safer due to early isolation of critical anatomical landmarks. Encouragement for the use of en-bloc ePLND, regardless of direction, is emphasized to improve prostate cancer staging accuracy and procedural standardization.

Dataset Information

Simple Techniques for Antegrade Guiding Catheter Engagement after Retrograde CTO Crossing.

Publications

Simple Techniques for Antegrade Guiding Catheter Engagement after Retrograde CTO Crossing.

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