Intracoronary snaring of the retrograde guidewire: A novel method to solve compartment mismatch in complex retrograde CTO PCI

Abstract

The retrograde approach has allowed a remarkable improvement in the success rate of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). After collateral channel crossing, the most crucial aspect of retrograde CTO PCI is creating the connection between the antegrade and retrograde system. Currently, the most common technique to achieve this is reverse controlled antegrade and retrograde subintimal tracking. However, this maneuver sometimes fails due to compartment mismatch (intraplaque situation of one wire and extraplaque situation of the other). New approaches are therefore needed to overcome challenges in this important step of the procedure. Here we present an innovative solution to this problem, which involved capturing the retrograde guidewire (advanced into a side branch at the distal cap) with a microsnare that had been advanced antegradely: this severed the dissection flap separating the antegrade and retrograde system, thus allowing us to successfully recanalize the CTO.

Effectiveness and safety of a novel modified homemade snare in retrograde percutaneous coronary intervention for chronic total occlusion lesions: a retrospective cohort study

“…With the development of CTO-PCI techniques, such as the parallel wire technique ( 11 ), antegrade dissection and re-entry ( 12 ), controlled antegrade and retrograde subintimal tracking (CART), reverse-CART technique ( 13 ), and capturing the retrograde guidewire (advanced into a side branch at the distal cap) with a micro snare ( 14 ), the success rate of CTO-PCI has dramatically improved ( 10 , 15 ). Although an antegrade attempt is always preferred over the retrograde approach as the initial strategy, the retrograde approach, which has more important steps and challenges, remains crucial for achieving a high success rate, especially in complex CTO lesions ( 16 , 17 ).…”