Maria Pia Hospital, GVM Care & Research, Turin, Italy.
San Giovanni Bosco Hospital, ASL Città Torino, Turin, Italy.
JACC Cardiovasc Interv. 2023 Aug 14;16(15):1833-1844. doi: 10.1016/j.jcin.2023.05.019.
Guiding catheter extensions (GCEs) have become indispensable tools in the modern approach to percutaneous coronary intervention (PCI). The support offered during complex PCI of uncrossable, or tortuous lesions is particularly valuable in the setting of chronic total occlusions (CTO), both for conventional anterograde wire escalation and for anterograde or retrograde dissection and re-entry techniques. This EuroCTO consensus document describes the use of GCE during CTO recanalization and provides a practical guide to anatomies and techniques in which these devices are applicable. We describe the peculiar features of the most-used device and the practical technique for GCE delivery in standard PCI; further specific indications for antegrade and retrograde CTO PCI are discussed in a specific section. In the antegrade approach, the GCEs may be useful to increase support or facilitate antegrade dissection and re-entry techniques, while in the retrograde approach for reverse controlled antegrade and retrograde tracking, to increase retrograde support for gear delivery, for treatment of CTO in bifurcation and ipsilateral externalization with a single guide catheter. The last section of the paper describes GCE-related complications, challenges, limitations, and future perspectives.
引导导管延长器（GCE）已成为经皮冠状动脉介入治疗（PCI）现代方法中不可或缺的工具。在无法通过或迂曲病变的复杂 PCI 中，GCE 提供的支持在慢性完全闭塞（CTO）的情况下特别有价值，无论是用于常规顺行导丝升级，还是用于顺行或逆行夹层和再进入技术。本 EuroCTO 共识文件描述了 GCE 在 CTO 再通中的应用，并提供了适用于这些设备的解剖和技术的实用指南。我们描述了最常用设备的特殊特征和在标准 PCI 中进行 GCE 输送的实用技术；在专门的一节中讨论了顺行和逆行 CTO PCI 的特定适应证。在顺行方法中，GCE 可用于增加支持或促进顺行夹层和再进入技术，而在逆行方法中用于逆行控制的顺行和逆行跟踪，以增加逆行支持用于输送器械，用于治疗单导丝同侧外展的分叉和 CTO。本文的最后一节描述了与 GCE 相关的并发症、挑战、局限性和未来展望。
