Fundamental Wire Technique and Current Standard Strategy of Percutaneous Intervention for Chronic Total Occlusion With Histopathological Insights

Sumitsuji, Satoru; Inoue, Katsumi; Ochiai, Masahiko; Tsuchikane, Etsuo; Ikeno, Fumiaki

doi:10.1016/j.jcin.2011.06.011

Cited by 162 publications

(101 citation statements)

References 22 publications

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“…17 Finally, NIC can occur on a stent strut that has been implanted with good apposition to the vessel wall in a thrombotic lesion, after dissolution of the thrombus, which results in PSS with grade 1 NIC. For example, CTO results from fresh thrombus, 18 and 64% of the lesions in this study were CTOs. Moreover, all the stents where Grade 1 NIC was observed at 27% of non-PSS sites in our study.…”

Section: Angioscopic Findingsmentioning

confidence: 77%

Angioscopic Assessment of Peri-Stent Contrast Staining Following Drug-Eluting Stent Implantation

Ishihara

Awata

Fujita

et al. 2014

Circ J

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Section: Angioscopic Findingsmentioning

confidence: 77%

Angioscopic Assessment of Peri-Stent Contrast Staining Following Drug-Eluting Stent Implantation

Ishihara

Awata

Fujita

et al. 2014

Circ J

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“…Many techniques and devices (wires, microcatheters) have been introduced into clinical practice to improve the effectiveness of CTO revascularisation (Sumitsuji et al, 2011). One of the most important and popular techniques is the retrograde approach, nowadays widely used, and first described in 1990 by Kahn and Hartzler (1990).…”

Section: Discussionmentioning

confidence: 99%

Chronic Total Coronary Artery Occlusion Recanalisation with Percutaneous Coronary Intervention — Single Centre 10-Year Experience

Kalniņš

Strēle

Kurcalte

et al. 2018

Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences.

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“…In general, the retrograde approach is considered for use when the antegrade approach is unsuccessful. 5) However, when the antegrade GC is engaged in the coronary artery during PCI for such CTO cases, it cannot be positioned in a coaxial manner with the coronary artery; therefore, the retrograde approach is often the first option. 6) The retrograde approach requires a step where the retrograde guidewire is passed through CTO for insertion into the antegrade GC.…”

Section: Discussionmentioning

confidence: 99%

A Novel Wiring Technique to Insert a Retrograde Guidewire Directly Into the Antegrade Guiding Catheter at the Ascending Aorta for Retrograde Percutaneous Recanalization of an Ostial Coronary Total Occlusion

et al. 2016

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SummaryIn recent years, the use of a retrograde approach has become a common practice in the treatment of chronic total occlusion (CTO) of the coronary ostium and artery with an anomalous origin. Use of this approach has increased the chances of a successful percutaneous coronary intervention (PCI). However, the approach requires capturing the retrograde guidewire within the aorta, which can often pose a problem. Therefore, we developed a technique in which the retrograde guidewire is passed through the CTO and inserted directly into the antegrade guiding catheter in the ascending aorta. This technique enabled the successful treatment of the ostial CTO of the right coronary artery using retrograde PCI. (Int Heart J 2016; 57: 503-506) Key words: Percutaneous coronary intervention, Chronic total occlusion, Retrograde approach, Right coronary ostium W ith the recent popularization of the retrograde approach, the initial success rate of percutaneous coronary intervention (PCI) for treating coronary chronic total occlusions (CTOs) has improved.1) The retrograde approach in particular has enabled initial success in treating CTOs with an anomalous origin as well as those of the coronary ostium, which are difficult to treat using antegrade PCI. However, coaxial positioning of the antegrade guiding catheter (GC) with the coronary artery is difficult in occlusal lesions such as these, which makes it difficult to insert the retrograde guidewire into the antegrade GC.2) Techniques for attaching the retrograde guidewire, such as the use of conventional snares or homemade snares, have been reported. However, these methods are time consuming, costly, and cause associated problems such as retrograde guidewire damage.3,4) We present here the case of a CTO lesion at the inlet of the right coronary artery for which externalization was successfully completed using a novel technique consisting of inserting the retrograde guidewire, which had been passed through the lesion by directly crossing the antegrade GC within the ascending aorta. This technique undoubtedly improved the safety and procedural duration pertaining to retrograde PCI in our case where it was difficult to insert the retrograde guidewire into the antegrade GC. Case ReportThe case subject was an 80-year-old man with coronary risk factors that included diabetes and a history of smoking. Thirteen years prior to the study he developed an anterior myocardial infarction for which a bare metal stent (BMS) was placed in the proximal left anterior descending artery. A BMS was also simultaneously placed in the proximal right coronary artery (RCA). Six years prior to the study, a sirolimus-eluting stent (SES) was placed in the central portion of the RCA to alleviate effort angina. However, shortness of breath on exertion persisted for 3 months so coronary angiography was performed. This confirmed total occlusion of the RCA in the ostium, and the contrast showed the RCA arising from the sinus ( Figure 1A). With respect to the left anterior descending artery (LAD), although th...

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Fundamental Wire Technique and Current Standard Strategy of Percutaneous Intervention for Chronic Total Occlusion With Histopathological Insights

Cited by 162 publications

References 22 publications

Angioscopic Assessment of Peri-Stent Contrast Staining Following Drug-Eluting Stent Implantation

Angioscopic Assessment of Peri-Stent Contrast Staining Following Drug-Eluting Stent Implantation

Chronic Total Coronary Artery Occlusion Recanalisation with Percutaneous Coronary Intervention — Single Centre 10-Year Experience

A Novel Wiring Technique to Insert a Retrograde Guidewire Directly Into the Antegrade Guiding Catheter at the Ascending Aorta for Retrograde Percutaneous Recanalization of an Ostial Coronary Total Occlusion

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