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Azzalini L, Carlino M. A new combined antegrade and retrograde approach for chronic total occlusion recanalization: Facilitated antegrade fenestration and re-entry. Catheter Cardiovasc Interv. 2021;98(1):E85-E90doi: 10.1002/ccd.29539.
Azzalini, L., & Carlino, M. (2021). A new combined antegrade and retrograde approach for chronic total occlusion recanalization: Facilitated antegrade fenestration and re-entry. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 98(1), E85-E90. https://doi.org/10.1002/ccd.29539
Azzalini, Lorenzo, and Carlino, Mauro. "A new combined antegrade and retrograde approach for chronic total occlusion recanalization: Facilitated antegrade fenestration and re-entry." Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions vol. 98,1 (2021): E85-E90. doi: https://doi.org/10.1002/ccd.29539
Azzalini L, Carlino M. A new combined antegrade and retrograde approach for chronic total occlusion recanalization: Facilitated antegrade fenestration and re-entry. Catheter Cardiovasc Interv. 2021 Jul 01;98(1):E85-E90. doi: 10.1002/ccd.29539. Epub 2021 Feb 08. PMID: 33555088.
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Catheter Cardiovasc Interv. 2021 Jul 01;98(1):E85-E90. doi: 10.1002/ccd.29539. Epub 2021 Feb 08.

A new combined antegrade and retrograde approach for chronic total occlusion recanalization: Facilitated antegrade fenestration and re-entry.

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions

Lorenzo Azzalini, Mauro Carlino

Affiliations

  1. Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA.
  2. Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.

PMID: 33555088 DOI: 10.1002/ccd.29539

Abstract

While antegrade techniques remain the cornerstone of chronic total occlusion (CTO) percutaneous coronary intervention (PCI), operators have often to resort to the retrograde approach in complex occlusions. In particular, lesions with proximal cap ambiguity, unclear vessel course and/or poor distal landing zone are difficult to tackle with either antegrade wiring or antegrade dissection and re-entry (ADR), and often require the retrograde approach. After collateral channel crossing, the retrograde approach usually culminates with either reverse controlled antegrade and retrograde subintimal tracking (CART) or retrograde true lumen crossing. Both techniques usually involve the use of an externalization wire, which requires keeping a higher activate clotting time to prevent thrombosis of the retrograde channel and is potentially associated with risk for donor vessel injury. In 2018, we described antegrade fenestration and re-entry (AFR), a targeted ADR technique in which fenestrations between the false and true lumen are created by antegrade balloon dilatation in the extraplaque space at the level of the distal cap, which are subsequently engaged by a polymer-jacketed wire to achieve re-entry. We hypothesized that AFR can also expedite antegrade crossing of the CTO after a wire has reached the distal vessel in a retrograde fashion. In this report, we present two cases in which we successfully achieved antegrade CTO crossing with AFR following retrograde advancement of a guidewire to the distal cap, in new variant of the technique, which we called "facilitated AFR".

© 2021 Wiley Periodicals LLC.

Keywords: antegrade; chronic total occlusion; percutaneous coronary intervention; re-entry; retrograde

References

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