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Antegrade Dissection and Reentry: Tools and Techniques. Interv Cardiol Clin 2020; 10:41-50. [PMID: 33223105 DOI: 10.1016/j.iccl.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The hybrid approach to chronic total occlusion percutaneous coronary intervention requires facility with antegrade and retrograde strategies to achieve high success rates in a time-efficient and safe manner. Antegrade dissection and reentry is an integral component of this approach but historically has been limited by low success rates and an inability to control the site of reentry. The advent of the BridgePoint device, and multiple iterations of technique in conjunction with its use, have markedly improved success rates and procedure efficiency.
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2
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The Wire Rendezvous and Chasing Wire Technique in the Bidirectional Approach for the Percutaneous Coronary Intervention for Chronic Total Occlusion with a Single Guiding Catheter. Case Rep Cardiol 2018; 2018:7162949. [PMID: 30510810 PMCID: PMC6232790 DOI: 10.1155/2018/7162949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/30/2018] [Indexed: 12/03/2022] Open
Abstract
A bidirectional approach for percutaneous coronary intervention for chronic total occlusion (CTO-PCI) using ipsilateral collaterals with a single guiding catheter limits procedural choices. The CTO of the left circumflex artery with ipsilateral collateral artery was treated by the bidirectional approach using a single guiding catheter. While the retrograde wire directly crossed the CTO lesion, the microcatheter could not pass the CTO lesion despite the conventional strategies. Therefore, we performed the wire rendezvous and chasing wire techniques. The wire rendezvous technique enables deeper retrograde guidewire progression, and the antegrade microcatheter can reach the CTO entry. The chasing wire technique enables the antegrade guidewire to pass the route made by the retrograde guidewire. These techniques might offer a possible solution for bidirectional CTO-PCI using a single guiding catheter. However, this technique should be considered as a last resort because of the risk of rapid reocclusion.
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Xenogiannis I, Tajti P, Burke MN, Brilakis ES. Staged revascularization in patients with acute coronary syndromes due to saphenous vein graft failure and chronic total occlusion of the native vessel: A novel concept. Catheter Cardiovasc Interv 2018; 93:440-444. [DOI: 10.1002/ccd.27978] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/19/2018] [Accepted: 10/23/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Iosif Xenogiannis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation; Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Peter Tajti
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation; Abbott Northwestern Hospital; Minneapolis Minnesota
- University of Szeged; Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center; Szeged Hungary
| | - M. Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation; Abbott Northwestern Hospital; Minneapolis Minnesota
| | - Emmanouil S. Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation; Abbott Northwestern Hospital; Minneapolis Minnesota
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Leibundgut G, Kaspar M. Chronic Total Occlusions. Interv Cardiol 2017. [DOI: 10.5772/68067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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5
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de la Torre Hernandez J, Rumoroso J, Subinas A, Gonzalo N, Ojeda S, Pan M, Martín Yuste V, Suárez A, Hernández F, Teruel L, Moreu J, Cubero J, Cascón J, Vinhas H, Lozano Í, Martin Moreiras J, Pérez de Prado A, Goicolea J, Escaned J. Percutaneous intervention in chronic total coronary occlusions caused by in-stent restenosis: procedural results and long-term clinical outcomes in the TORO (Spanish registry of chronic TOtal occlusion secondary to an occlusive in-stent RestenOsis) multicentre registry. EUROINTERVENTION 2017; 13:e219-e226. [DOI: 10.4244/eij-d-16-00764] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Rangan BV, Kotsia A, Christopoulos G, Spratt J, Rinfret S, Banerjee S, Brilakis ES. The Hybrid Approach to Intervention of Chronic Total Occlusions. Curr Cardiol Rev 2015; 11:299-304. [PMID: 26354507 PMCID: PMC4774633 DOI: 10.2174/1573403x11666150909113026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/04/2015] [Indexed: 11/24/2022] Open
Abstract
The “hybrid” approach to chronic total occlusion (CTO) percutaneous coronary intervention (PCI) was developed to provide guidance on optimal crossing strategy selection. Dual angiography remains the cornerstone of clinical decision making in CTO PCI. Four angiographic parameters are assessed: (a) morphology of the proximal cap (clear-cut or ambiguous); (b) oc-clusion length;
(c) distal vessel size and presence of bifurcations beyond the distal cap; and (d) location and suitability of a retrograde con-duit (collateral channels or bypass grafts) for retrograde access. Antegrade wire escalation is favored for short
(<20 mm) occlusions, usually escalating rapidly from a soft tapered-tip polymer-jacketed guidewire to a stiff
polymer-jacketed or tapered-tip guidewire. Antegrade dissection/re-entry is favored in long (≥20 mm long) occlusions, try-ing to minimize the dissection length by re-entering into the distal true lumen immediately after the occlusion. Primary retro-grade approach is preferred for lesions with an ambiguous proximal cap, poor distal target, good interventional collaterals, and heavy calcification, as well as chronic kidney disease. The “hybrid” approach advocates early change between strategies to enable CTO crossing in the most efficacious, efficient, and safe way. Several early studies are demonstrating high success and low complication rates with use of the “hybrid” approach, supporting its expanding use in CTO PCI.
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Affiliation(s)
| | | | | | | | | | | | - Emmanouil S Brilakis
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Christopoulos G, Karmpaliotis D, Alaswad K, Lombardi WL, Grantham JA, Rangan BV, Kotsia AP, Lembo N, Kandzari DE, Lee J, Kalynych A, Carlson H, Garcia S, Banerjee S, Thompson CA, Brilakis ES. The efficacy of "hybrid" percutaneous coronary intervention in chronic total occlusions caused by in-stent restenosis: insights from a US multicenter registry. Catheter Cardiovasc Interv 2014; 84:646-51. [PMID: 24585508 DOI: 10.1002/ccd.25465] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 02/18/2014] [Accepted: 02/25/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To examine the success and complication rates in percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) caused by in-stent restenosis (ISR). BACKGROUND PCI for in-stent total occlusive disease has traditionally been associated with low success rates. We sought to examine angiographic and procedural outcomes of patients who underwent CTO PCI due to ISR using the novel "hybrid" algorithm, and compare them with patients with de novo CTOs. METHODS We examined 521 consecutive patients who underwent CTO PCI at five high-volume PCI centers in the United States using the "hybrid" approach. Clinical, angiographic, and procedural outcomes were compared between CTOs due to ISR and de novo CTOs. RESULTS The target CTO was due to ISR in 57 of 521 patients (10.9%). Compared to patients with de novo CTOs, those with CTO due to ISR had higher frequency of diabetes (56.1% vs. 39.6%, P = 0.02) and less calcification (5.3% vs. 16.2%, P <0.001), but longer occlusion length [38 (29-55) vs. 30 (20-51), P = 0.04]. Technical success in the ISR and de novo group was 89.4% and 92.5% (P = 0.43), respectively; procedural success was 86.0% and 90.3% (P = 0.31), respectively; and the incidence of major adverse cardiac events was 3.5% and 2.2% (P = 0.63), respectively. CONCLUSIONS Use of the "hybrid" approach to CTO PCI was associated with similarly high procedural success and similarly low major complication rates in patients with de novo and ISR CTOs.
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Advances in the management of coronary chronic total occlusions. J Cardiovasc Transl Res 2014; 7:426-36. [PMID: 24634196 DOI: 10.1007/s12265-014-9556-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 02/24/2014] [Indexed: 12/16/2022]
Abstract
Chronic total occlusions (CTOs) have been called "the last frontier" of percutaneous coronary intervention (PCI) due to traditionally low success rates and high risk for restenosis and re-occlusion. Recent advances in equipment and crossing techniques have significantly increased CTO PCI success rates while maintaining low risk of complications. Specifically, the retrograde approach and controlled antegrade dissection and re-entry in conjunction with advanced guidewires and microcatheters have significantly improved procedural success rates. Moreover, the introduction of the "hybrid" approach has created a unified framework for operators to approach CTOs in a systematic and efficient fashion. Finally, drug-eluting stents, especially second generation, have improved long-term patency after CTO PCI.
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MICHAEL TESFALDETT, MOGABGAB OWEN, FUH ERIC, PATEL VISHALG, EL SABBAGH ABDALLAH, ALOMAR MOHAMMEDE, RANGAN BAVANAV, ABDULLAH SHUAIBM, BANERJEE SUBHASH, BRILAKIS EMMANOUILS. Application of the “Hybrid Approach” to Chronic Total Occlusion Interventions: A Detailed Procedural Analysis. J Interv Cardiol 2013; 27:36-43. [DOI: 10.1111/joic.12083] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- TESFALDET T. MICHAEL
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - OWEN MOGABGAB
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - ERIC FUH
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - VISHAL G. PATEL
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - ABDALLAH EL SABBAGH
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - MOHAMMED E. ALOMAR
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - BAVANA V. RANGAN
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - SHUAIB M. ABDULLAH
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - SUBHASH BANERJEE
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
| | - EMMANOUIL S. BRILAKIS
- VA North Texas Health Care System and University of Texas Southwestern Medical Center; Dallas Texas
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Azemi T, Fram DB, Hirst JA. Bailout antegrade coronary reentry with the stingray™ balloon and guidewire in the setting of an acute myocardial infarction and cardiogenic shock. Catheter Cardiovasc Interv 2013; 82:E211-4. [PMID: 23404924 DOI: 10.1002/ccd.24826] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 01/02/2013] [Accepted: 01/10/2013] [Indexed: 11/09/2022]
Abstract
Emergent coronary artery bypass surgery for failed percutaneous coronary intervention (PCI) during acute myocardial infarction (MI) is a bailout strategy that is associated with a high in-hospital morbidity and mortality (7-10%). Innovative strategies to improve the probability of PCI success in this setting are needed. Antegrade coronary re-entry with the Stingray™ balloon and guidewire has been shown to facilitate recanalization of chronic total occlusions in stable patients. We report a case where the Stingray™ device was successfully used as a bailout strategy in the setting of an acute MI complicated by cardiogenic shock.
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Affiliation(s)
- Talhat Azemi
- Cardiac Cathetrization Laboratory, Henry Low Heart Center, Hartford Hospital, Hartford, Connecticut
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Michael TT, Papayannis AC, Banerjee S, Brilakis ES. Subintimal dissection/reentry strategies in coronary chronic total occlusion interventions. Circ Cardiovasc Interv 2013; 5:729-38. [PMID: 23074346 DOI: 10.1161/circinterventions.112.969808] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Subintimal dissection/reentry techniques are increasingly being used for crossing coronary chronic total occlusions both antegradely (using a knucle wire or the Bridgepoint system) or retrogradely (using the controlled antegrade and retrograde tracking and dissection, and reverse controlled antegrade and retrograde tracking and dissection technique). Subintimal dissection/reentry techniques can increase procedural success rates, but their subsequent clinical outcomes are poorly studied, and they appear to be associated with high rates of in-stent restenosis and repeat target lesion revascularization. In the present review, we describe in detail the chronic total occlusions subintimal dissection/reentry techniques, clarify the related terminology and summarize the published studies in this area and the current gaps of knowledge.
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Affiliation(s)
- Tesfaldet T Michael
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX 75216, USA
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Martinez-Rumayor AA, Banerjee S, Brilakis ES. Knuckle Wire and Stingray Balloon for Recrossing a Coronary Dissection After Loss of Guidewire Position. JACC Cardiovasc Interv 2012; 5:e31-2. [DOI: 10.1016/j.jcin.2012.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 05/12/2012] [Indexed: 10/27/2022]
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Abstract
The hybrid approach to chronic total occlusion percutaneous coronary intervention requires facility with antegrade and retrograde strategies to achieve high success rates in a time-efficient and safe manner. Antegrade dissection and reentry is an integral component of this approach but historically has been limited by low success rates and an inability to control the site of reentry. The advent of the BridgePoint device, and multiple iterations of technique in conjunction with its use, have markedly improved success rates and procedure efficiency.
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Affiliation(s)
- R Michael Wyman
- Cardiovascular Interventional Research, Torrance Memorial Medical Center, 3445 Pacific Coast Highway, Suite 100, Torrance, CA 90505, USA.
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Whitlow PL, Burke MN, Lombardi WL, Wyman RM, Moses JW, Brilakis ES, Heuser RR, Rihal CS, Lansky AJ, Thompson CA. Use of a Novel Crossing and Re-Entry System in Coronary Chronic Total Occlusions That Have Failed Standard Crossing Techniques. JACC Cardiovasc Interv 2012; 5:393-401. [DOI: 10.1016/j.jcin.2012.01.014] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 01/21/2012] [Indexed: 10/28/2022]
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15
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Hussain F, Golian M, Tam JW. A complex dissected chronic occlusion: targeted balloon dilatation of false lumen to access true lumen, combined localized subintimal tracking and re-entry, parallel wire, contralateral injection and a useful antegrade lumen re-entry technique. Heart Int 2012; 7:e7. [PMID: 22690300 PMCID: PMC3366303 DOI: 10.4081/hi.2012.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 03/04/2012] [Accepted: 03/05/2012] [Indexed: 11/25/2022] Open
Abstract
Chronic total occlusion (CTO) angioplasty is one of the most challenging procedures remaining for the interventional operator. Recanalizing CTOs can improve exercise capacity, symptoms, left ventricular function and possibly reduce mortality. Multiple strategies such as escalating wire, parallel wire, see-saw, contralateral injection, subintimal tracking and re-entry (STAR), retrograde wire techniques (controlled antegrade retrograde subintimal tracking, CART), reverse CART, confluent balloon, rendezvous in coronary, and other techniques have all been described. Selection of the most appropriate approach is based on assessment of vessel course, length of occluded segment, presence of bridging collaterals, presence of bifurcating side branches at the occlusion site, and other variables. Today, with significant operator expertise and the use of available techniques, the literature reports a 50–95% success rate for recanalizing CTOs.
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Affiliation(s)
- Farrukh Hussain
- St. Boniface General Hospital, University of Manitoba, Canada
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Sumitsuji S, Inoue K, Ochiai M, Tsuchikane E, Ikeno F. Fundamental wire technique and current standard strategy of percutaneous intervention for chronic total occlusion with histopathological insights. JACC Cardiovasc Interv 2012; 4:941-51. [PMID: 21939933 DOI: 10.1016/j.jcin.2011.06.011] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 06/15/2011] [Accepted: 06/23/2011] [Indexed: 12/17/2022]
Abstract
Currently, successful treatment of chronic total occlusion (CTO) seems markedly improved, due to several new techniques and dedicated device developments. However, this improved success rate is often limited to procedures performed by skilled, highly experienced operators. To improve the overall success rate of percutaneous coronary intervention of CTO from a worldwide perspective, a deeper understanding of CTO histopathology might offer insights into the development of new techniques and procedural strategies. In this review, CTO histopathology and wire techniques are discussed on the basis of the fundamental concepts of antegrade and retrograde approaches. Although details pertaining to wire manipulation are very difficult to explain objectively, we tried to describe this as best as possible in this article. Finally, a systematic review of the current standard CTO strategy is provided. Hopefully, this article will enhance the understanding of this complex procedure and, consequently, promote safe and effective CTO-percutaneous coronary intervention for patients who present with this challenging lesion subset.
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Affiliation(s)
- Satoru Sumitsuji
- Nozaki Tokushukai Hospital, Nagoya Tokushukai General Hospital and Osaka University, Osaka, Japan
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Papayannis A, Banerjee S, Brilakis ES. Use of the crossboss catheter in coronary chronic total occlusion due to in-stent restenosis. Catheter Cardiovasc Interv 2011; 80:E30-6. [DOI: 10.1002/ccd.23188] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 03/28/2011] [Accepted: 03/29/2011] [Indexed: 11/09/2022]
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Ball T, Banerjee S, Brilakis ES. Use of the Venture catheter to shorten the door-to-balloon time in patients with ST-Segment elevation acute myocardial infarction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2011; 12:391-8. [PMID: 21741323 DOI: 10.1016/j.carrev.2011.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 05/05/2011] [Accepted: 05/12/2011] [Indexed: 10/18/2022]
Abstract
Achieving a door-to-balloon time < 90 min may be challenging in patients with ST-segment elevation acute myocardial infarction with difficult to wire coronary lesions. We report use of the Venture wire control catheter to facilitate wiring in four patients with significant tortuosity proximal to a thrombotic coronary occlusion, after conventional wiring attempts failed. Early use of the Venture catheter may help shorten the door-to-balloon time in patients with challenging to wire lesions.
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Affiliation(s)
- Timothy Ball
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75216, USA
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Abdel-karim ARR, Lombardi WB, Banerjee S, Brilakis ES. Contemporary outcomes of percutaneous intervention in chronic total coronary occlusions due to in-stent restenosis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2011; 12:170-176. [DOI: 10.1016/j.carrev.2010.08.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 08/04/2010] [Accepted: 08/05/2010] [Indexed: 11/24/2022]
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Brilakis ES, Grantham JA, Banerjee S. “Ping-pong” guide catheter technique for retrograde intervention of a chronic total occlusion through an ipsilateral collateral. Catheter Cardiovasc Interv 2011; 78:395-9. [DOI: 10.1002/ccd.22870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 10/10/2010] [Indexed: 11/10/2022]
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Use of the Stingray Re-Entry System in Two Complex Cases of Occluded Superficial Femoral Arteries. Case Rep Vasc Med 2011; 2011:976312. [PMID: 22937470 PMCID: PMC3420382 DOI: 10.1155/2011/976312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 06/30/2011] [Indexed: 11/17/2022] Open
Abstract
Totally occluded infrainguinal arterial disease presents formidable challenges to endovascular revascularization. A variety of devices have been made available to make the crossing of these lesions more amenable to endovascular techniques. We discuss the novel use of a device that has been developed for crossing occluded coronary arteries, the Stingray Re-Entry System.
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