Acceso a ramas laterales con origen muy anguladoUtilidad de una guía específica de oclusión crónica

  1. Iñigo Lozano 1
  2. Juan Rondán 1
  3. Jose Miguel Vegas Valle 1
  4. Julio García Rubio 1
  5. Sergio Santos 1
  6. Eduardo Segovia 1
  1. 1 Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, España
Journal:
REC: Interventional Cardiology

ISSN: 2604-7276,  2604-7306

Year of publication: 2019

Volume: 1

Issue: 1

Pages: 21-25

Type: Article

DOI: 10.24875/RECIC.M19000004 DIALNET GOOGLE SCHOLAR lock_openDialnet editor

More publications in: REC: Interventional Cardiology

Abstract

Introduction and objectives: Accessing sharply angulated side branches using intracoronary guidewires sometimes poses great challenges, and even after using its distal end for accessing purposes, it usually prolapses inside the main vessel. We hereby present an easy way to perform these procedures using a specific guidewire for the management of chronic total occlusions. Methods: From January 2017 through September 2018, patients with lesions on sharply angulated side or large branches that required protection in bifurcations were approached using straight, angled tip and/or double-lumen microcatheters with regular guidewires. In cases of unsuccessful access, a specific wire designed for chronic total occlusions was used with the straight tip microcatheter after a drastic overhaul of the shape in its distal end. Results: In 9 patients access to the side branch was not achieved with the initial strategy, in 3 patients due to access inability and in the remaining 6 due to guidewire prolapse when trying to advance the microcatheter. In all 9 cases, the access could be completed using the Gaia First guidewire that combines an excellent torque with enough rigidity to prevent the prolapse of the tip. All procedures were performed without complications. Conclusions: The percutaneous coronary intervention of sharply angulated side branches can be challenging when advancing the guidewire. However, these procedures can be performed easily and quickly with a specific guidewire for the managemenf of chronic total occlusions.

Bibliographic References

  • 1. Pan M, Suarez de Lezo J, Medina A, et al. Drug-eluting stents for the treatment of bifurcation lesions:a randomized comparison between paclitaxel and sirolimus stents. Am Heart J. 2007;153:15e1-7.
  • 2. Lee HF, Chou SH, Tung YC, Lin CP, Ko YS, Chang CJ. Crusade Microcatheter-Facilitated Reverse Wire Technique for Revascularization of Bifurcation Lesions of Coronary Arteries. Acta Cardiol Sin. 2018;34:31-36.
  • 3. McClure SJ, Wahr DW, Webb JG. Venture wire control catheter. Catheter Cardiovasc Interv. 2005;66:346-350.
  • 4. Ojeda S, Pan M, Mazuelos F, et al. Use of the venture wire-control catheter for accessing side branches during provisional stenting:an option for bifurcations with an unfavorable anatomy. Rev Esp Cardiol. 2010;63:1487-1491.
  • 5. Cortese B, Limbruno U. Coronary bifurcation lesions:innovative approaches and the future of bifurcation devices. Future Cardiol. 2010;6:221-230.
  • 6. Burzotta F, De Vita M, Sgueglia G, Todaro D, Trani C. How to solve difficult side branch access? EuroIntervention. 2010;6:J72-80.
  • 7. Khalili H, Vo MN, Brilakis ES. Initial Experience With the Gaia Composite Core Guidewires in Coronary Chronic Total Occlusion Crossing. J Invasive Cardiol. 2016;28:E22-25.
  • 8. Kawasaki T, Koga H, Serikawa T. New bifurcation guidewire technique:a reversed guidewire technique for extremely angulated bifurcation — a case report. Catheter Cardiovasc Interv. 2008;71:73-76.
  • 9. Nomura T, Higuchi Y, Kato T. Successful percutaneous coronary intervention for complex bifurcated lesions with combination of “Reverse wire technique“and “Reverse bent wiring with the crusade catheter“ novel wire manipulation technique. Catheter Cardiovasc Interv. 2016;87:920-925.
  • 10. Nomura T, Higuchi Y, Kubota H, et al. Practical Usefulness of Dual Lumen Catheter-Facilitated Reverse Wire Technique for Markedly Angulated Bifurcated Lesions. J Interv Cardiol. 2015;28:544-550.
  • 11. Nomura T, Kikai M, Hori Y, et al. Tips of the dual-lumen microcatheter-facilitated reverse wire technique in percutaneous coronary interventions for markedly angulated bifurcated lesions. Cardiovasc Interv Ther. 2018;33:146-153.
  • 12. Suzuki G, Nozaki Y, Sakurai M. A novel guidewire approach for handling acute-angle bifurcations:reversed guidewire technique with adjunctive use of a double-lumen microcatheter. J Invasive Cardiol. 2013;25:48-54.
  • 13. Lilli A, Vecchio S, Giuliani G, et al. Venture wire control catheter in percutaneous treatment of complex coronary bifurcation. A case report. Minerva Cardioangiol. 2008;56:255-258.
  • 14. He X, Gao B, Liu Y, Li Z, Zeng H. Side-branch technique for difficult guidewire placement in coronary bifurcation lesion. Cardiovasc Revasc Med. 2016;17:59-62.
  • 15. Chen SL, Louvard Y, Runlin G. Perspective on bifurcation PCI. J Interv Cardiol. 2009;22:99-109.
Data source: Dialnet