When antegrade microcatheter does not follow: The “facilitated tip‐in technique”

Venuti, Giuseppe; D’Agosta, Guido; Tamburino, Corrado; Manna, Alessio La

doi:10.1002/ccd.28803

Cited by 5 publications

(2 citation statements)

References 6 publications

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“…Third, insert the retrograde wire into the antegrade microcatheter as far as possible or insert the back end of an extra-guidewire into the antegrade MC, as introduced by Giuseppe Venuti etc. 14 In this study, the overall procedural time and radiation dose showed a trend to decrease in the tip-in group but it had not reached statistical significance yet. Even though the wire externalization process costs more time, externalized wire provides substantial support that may facilitate and expedite other parts of the procedure.…”

Section: Discussionmentioning

confidence: 53%

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Efficiency of the Guide Extension Catheter-Facilitated Tip-in Technique in the Recanalization of Coronary Chronic Total Occlusion

Zhou,

Deng,

Wang

et al. 2023

JMDH

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Background The tip-in technique, which involves advancing an antegrade microcatheter cross the lesion over a retrograde guidewire, is an elaborated maneuver in the recanalization of coronary chronic total occlusion (CTO). We seek to assess the efficiency of a guide extension catheter-facilitated tip-in technique in comparison to the traditional retrograde approach, which is accomplished by an externalization wire. Methods Thirty-three CTO patients successfully revascularized using guide extension catheter-facilitated “tip-in” were included and matched with another 33 patients by J-CTO score and operators, whose CTO was recanalized using an externalized wire. The manipulation time from the first retrograde wire entering the antegrade guide to the first antegrade balloon inflation in the occlusion was calculated. Results Compared with the wire-externalization group, the manipulation time in the tip-in group was significantly shortened [389s; interquartile range (IQR), 272–478 vs 706s; IQR, 560–914; p < 0.001]. There was a trend in decreasing total operation time and radiation dose, but it did not reach statistical significance. Conclusion Guide extension catheter-facilitated tip-in is an efficient method to achieve the recanalization of CTO in a retrograde way, which would be pivotal when the retrograde microcatheter could not be advanced into the antegrade guide catheter.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Efficiency of the Guide Extension Catheter-Facilitated Tip-in Technique in the Recanalization of Coronary Chronic Total Occlusion

Zhou,

Deng,

Wang

et al. 2023

JMDH

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Comprehensive Overview of Retrograde‐Antegrade Connection Techniques Without Externalization in Chronic Total Occlusion PCI: The Portal Techniques

Ungureanu,

Avran,

Brilakis

et al. 2024

Cathet Cardio Intervent

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BackgroundAdvancing the retrograde microcatheter (MC) into the antegrade guide catheter during retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can be challenging or impossible, preventing guidewire externalization.ObjectivesTo detail and evaluate all the techniques focused on wiring to achieve intubation of the distal tip of a microcatheter, balloon, or stent with an antegrade or retrograde guidewire, aiming to reduce complications by minimizing tension on fragile collaterals during externalization and enabling rapid antegrade conversion in various clinical scenarios.MethodsWe describe the two main techniques, tip‐in and rendezvous, and their derivatives such a facilitated tip‐in, manual MC‐tip modification, tip‐in the balloon, tip‐in the stent, deep dive rendezvous, catch‐it and antegrade microcatheter probing. We provide case studies that demonstrate the effectiveness of these techniques in complex scenarios involving extreme vessel angulation, severe calcification, fragile collaterals, and challenging retrograde MC crossing without externalization.ConclusionThe development of advanced variants along with traditional techniques to establish retrograde guidewire connection and antegrade conversion has led to the establishment of a cohesive group of methods known as portal techniques. These approaches serve as strategic advantages in retrograde CTO‐PCI, providing a valuable and feasible alternative to conventional retrograde connection techniques, particularly when those techniques fail. Their ability to avoid the externalization process reduces potential damage to collateral channels and the ostium of the donor artery, potentially leading to a reduction in complication rates.

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Chronic Total Occlusion PCI Techniques in 2020

Zografos

Tsiafoutis

Tsoumeleas

et al. 2021

Curr Treat Options Cardio Med

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When antegrade microcatheter does not follow: The “facilitated tip‐in technique”

Cited by 5 publications

References 6 publications

Efficiency of the Guide Extension Catheter-Facilitated Tip-in Technique in the Recanalization of Coronary Chronic Total Occlusion

Efficiency of the Guide Extension Catheter-Facilitated Tip-in Technique in the Recanalization of Coronary Chronic Total Occlusion

Comprehensive Overview of Retrograde‐Antegrade Connection Techniques Without Externalization in Chronic Total Occlusion PCI: The Portal Techniques

Chronic Total Occlusion PCI Techniques in 2020

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