Simplified dual-lumen catheter-facilitated reverse wire technique for markedly angulated collateral channel entry in retrograde chronic total occlusion intervention

Abstract

The retrograde approach has significantly improved the success rates in complex coronary total occlusion (CTO) lesions. It has also become the predominant and important strategy in CTO recanalization. However, unsuccessful crossing of the collateral channels is the strongest predictor of retrograde failure, and adverse collateral channel morphology, including large channel entry angle, could reduce the success rate of collateral channel crossing. Reverse wire technique (RWT) was specifically developed for bifurcation lesions with an extremely angulated side branch, and nowadays, this can be achieved by the support of a dual-lumen catheter (DLC). We report a novel method named “simplified dual-lumen catheter-facilitated RWT” to facilitate markedly angulated collateral channel entry in retrograde CTO intervention. This new technique is simplified by making the reverse bend with the support of a DLC in the aorta instead of outside the guiding catheter, which is feasible, effective, and safe for markedly angulated collateral channel entry in retrograde CTO percutaneous coronary intervention (PCI).