Ungureanu Claudiu, Avran Alexandre, Brilakis Emmanouil S, Mashayekhi Kambis, Alaswad Khaldoon, Agostoni Pierfrancesco, Gasparini Gabriele, Colletti Giuseppe, Cocoi Mihai, Achim Alexandru, Wu Eugene B, Novotný Vojtěch, Kovacic Mihajlo, Rathore Sudhir, La Manna Alessio, Noterdaeme Timothée, Gach Olivier, Bozinovic Nenad, Novelli Laura, Leibundgut Gregor
Cardiovascular Jolimont Hospital, La Louvière, Belgium.
Department of Cardiovascular, Hôpital Valenciennes, Valenciennes, France.
Catheter Cardiovasc Interv. 2025 Jan;105(1):11-22. doi: 10.1002/ccd.31346. Epub 2024 Dec 12.
Advancing 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.
To 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.
We 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.
The 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.
在逆向慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）过程中，将逆向微导管（MC）推进到顺向导引导管内可能具有挑战性甚至无法完成，从而阻碍导丝引出。
详细介绍并评估所有专注于导丝操作的技术，以实现用顺向或逆向导丝将微导管、球囊或支架的远端插入，旨在通过在外化过程中最小化对脆弱侧支的张力并在各种临床情况下实现快速顺向转换来减少并发症。
我们描述了两种主要技术，即尖端插入法和会师法，以及它们的衍生技术，如简易尖端插入法、手动微导管尖端改良法、球囊尖端插入法、支架尖端插入法、深度会师法、捕捉法和顺向微导管探查法。我们提供了案例研究，展示了这些技术在涉及极端血管成角、严重钙化、脆弱侧支以及逆向微导管难以通过且无法引出的复杂情况下的有效性。
先进变体技术与传统技术的发展相结合，用于建立逆向导丝连接和顺向转换，形成了一组连贯的方法，即所谓的门户技术。这些方法在逆向CTO-PCI中具有战略优势，为传统逆向连接技术提供了有价值且可行的替代方案，特别是在那些技术失败时。它们避免引出过程的能力减少了对侧支通道和供血动脉开口的潜在损伤，可能导致并发症发生率降低。
