Controlled antegrade intimal tracking with subintimal balloon inflation as a novel bailout technique for chronic total occlusion after failed intravascular ultrasound-guided parallel wire technique

Cardiovasc Revasc Med. 2017 Oct-Nov;18(7):521-525. doi: 10.1016/j.carrev.2017.04.013. Epub 2017 Apr 24.

Abstract

Failure to cross with a guidewire is the most common reason for failure of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). In cases of CTO PCI with no interventional collaterals, an intravascular ultrasound (IVUS)-guided parallel wire technique is usually the last-resort procedure. Failure of this technique sometimes causes enlarged subintimal space, resulting in procedure failure. We present a successful second attempt at left anterior descending artery CTO PCI with no interventional collaterals. After IVUS-guided parallel wire technique failed with an enlarged subintimal space, successful antegrade wire crossing was achieved using controlled antegrade intimal tracking with balloon inflation in the subintimal space to deflect a second wire. This technique may be useful as a bailout strategy in otherwise-failed CTO PCI with an enlarged subintimal space.

Keywords: Antegrade approach; Bailout technique; Chronic total occlusion; Enlarged subintimal space.

Publication types

  • Case Reports

MeSH terms

  • Aged, 80 and over
  • Angioplasty, Balloon, Coronary / adverse effects
  • Angioplasty, Balloon, Coronary / methods*
  • Chronic Disease
  • Coronary Angiography
  • Coronary Occlusion / diagnostic imaging
  • Coronary Occlusion / therapy*
  • Female
  • Humans
  • Salvage Therapy
  • Treatment Failure
  • Ultrasonography, Interventional*