Carlino to the rescue: Use of intralesion contrast injection for bailout antegrade and retrograde crossing of complex chronic total occlusions

Amsavelu, Suwetha; Carlino, Mauro; Brilakis, Emmanouil S.

doi:10.1002/ccd.26418

Cited by 19 publications

(7 citation statements)

References 24 publications

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“…Re-entry can be achieved spontaneously with subintimal tracking and re-entry (STAR); with contrast-guided STAR, during which injection of contrast aids in delineation of the dissection plane (18-20); mini-STAR, which involves minimal subintimal tracking and early re-entry (21); and limited antegrade subintimal tracking (LAST), during which a stiffer wire such as the Confianza Pro 12 (Asahi Intecc) or Pilot 200 (Abbott Vascular) is used to re-enter just distal to the lesion (2). …”

Section: Discussionmentioning

confidence: 99%

Use of antegrade dissection re-entry in coronary chronic total occlusion percutaneous coronary intervention in a contemporary multicenter registry

Danek

Karatasakis

Karmpaliotis

et al. 2016

International Journal of Cardiology

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Background We assessed efficacy and safety of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) using antegrade dissection re-entry (ADR). Methods We examined outcomes of ADR among 1,313 CTO PCIs performed at 11 US centers between 2012-2015. Results 84.1% of patients were men. Prevalence of prior coronary artery bypass graft surgery was 34.3%. Overall technical and procedural success were 90.1% and 88.7%, respectively. In-hospital major adverse cardiovascular events (MACE) occurred in 31 patients (2.4%). ADR was used in 458 cases (34.9%), and was the first strategy in 169 cases (12.9 %). ADR cases were angiographically more complex than non-ADR cases (mean J-CTO score: 2.8±1.2 vs. 2.4±1.2, p<0.001). ADR was performed using the CrossBoss catheter in 246 of 458 (53.7%) and the Stingray system in 251 ADR cases (54.8%). Compared with non-ADR cases, ADR cases had lower technical (86.9% vs. 91.8%, p=0.005) and procedural success (85.0% vs. 90.7%, p=0.002), but similar risk for MACE (2.9% vs. 2.2%, p=0.42). ADR was associated with longer procedure and fluoroscopy time, and higher patient air kerma dose and contrast volume (all p<0.001). After excluding retrograde cases, ADR and antegrade wire escalation (AWE) had similar technical success (92.7% vs. 94.2%, p=0.43) procedural success (91.8% vs. 94.1%, p=0.23), and MACE (2.1% vs. 0.6%, p=0.12). Conclusions ADR is used relatively frequently in contemporary CTO PCI, especially for challenging lesions and after failure of other strategies. ADR is associated with similar success rates and risk for complications as compared with AWE, and is important for achieving high procedural success.

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Section: Discussionmentioning

confidence: 99%

Use of antegrade dissection re-entry in coronary chronic total occlusion percutaneous coronary intervention in a contemporary multicenter registry

Danek

Karatasakis

Karmpaliotis

et al. 2016

International Journal of Cardiology

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“…Contrast injection through a microcatheter was developed by Mauro Carlino to facilitate crossing of CTOs, by overcoming resistance to wire advancement and helping resolve ambiguity in the vessel course (Table 1). Initially contrast injection was aggressive with potential risk of complications, 8–10 but in its current form a small amount (1–2 cc) of contrast is injected gently 11,12 . Similarly, in the “guide‐extension Carlino” technique we recommend injection of a small amount of contrast (2–3 cc) through a distally advanced guide extension with dampened pressure waveform under fluoroscopy.…”

Section: Discussionmentioning

confidence: 99%

Guide‐Extension Carlino: A novel technique for crossing a microcatheter uncrossable proximal cap during chronic total occlusion interventions

Karácsonyi

Brilakis

Chandwaney

2022

Cathet Cardio Intervent

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“…All these modifi- The microchannel technique has evolved into what is currently known as the "Carlino technique". 9 In the current iteration, an even smaller volume of contrast media (<0.5 mL) is injected inside the occlusion, with the goal of modifying plaque compliance to facilitate guidewire and microcatheter advancement through a fibrocalcific plaque. Knowledge and understanding of CTO histopathology may explain why this maneuver can be effective.…”

Section: Introductionmentioning

confidence: 99%

Contrast modulation in chronic total occlusion percutaneous coronary intervention

Azzalini

Uretsky

Brilakis

et al. 2018

Cathet Cardio Intervent

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The intraplaque injection of contrast media in the recanalization of coronary chronic total occlusions (CTO) has witnessed a dynamic journey since its initial formulation. Contrast‐guided subintimal tracking and re‐entry (STAR) was the first contrast modulation technique for CTO percutaneous coronary intervention (PCI). With this technique, a forceful injection of a large volume of contrast (3–4 mL) was performed in order to achieve hydraulic recanalization of the vessel. This approach was associated with extensive vessel injury and unpredictable true lumen re‐entry, which were in turn linked to high rates of restenosis on follow‐up. In the subsequent iteration, called the “microchannel technique”, a smaller amount of contrast media (1 mL) was gently injected inside the plaque to modify its compliance by softening and recruiting loose tissue, which facilitated subsequent true‐to‐true lumen crossing with a polymer‐jacketed wire along paths of least resistance. The microchannel technique has later evolved into what is currently known as the “Carlino technique”, where a minimal volume of contrast media (<0.5 mL) is gently injected inside the occlusion, with the goal of modifying plaque compliance to facilitate guidewire and microcatheter advancement through a fibrocalcific plaque. The Carlino technique is now widely utilized to allow negotiation of difficult‐to‐cross occlusions, particularly by the “hybrid operators”, with high success rates and low incidence of complications. The purpose of this article is to provide a historical perspective on the use of contrast modulation in CTO PCI, its pathophysiological basis, as well as technical recommendations on how and when to perform these maneuvers.

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Carlino to the rescue: Use of intralesion contrast injection for bailout antegrade and retrograde crossing of complex chronic total occlusions

Cited by 19 publications

References 24 publications

Use of antegrade dissection re-entry in coronary chronic total occlusion percutaneous coronary intervention in a contemporary multicenter registry

Use of antegrade dissection re-entry in coronary chronic total occlusion percutaneous coronary intervention in a contemporary multicenter registry

Guide‐Extension Carlino: A novel technique for crossing a microcatheter uncrossable proximal cap during chronic total occlusion interventions

Contrast modulation in chronic total occlusion percutaneous coronary intervention

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