title: Subintimal TRAnscatheter Withdrawal (STRAW) of hematomas compressing the distal true lumen: a novel technique to facilitate distal reentry during recanalization of chronic total occlusion (CTO).
abstract: The development of a large hematoma impairing visualization of the distal true lumen is a recognized complication of antegrade recanalization of chronic total occlusions, often forcing the operator to abort the procedure or switch to a retrograde approach. We describe a novel technique utilizing an over-the-wire balloon inflated in the proximal occluded vessel to block inflow and allow aspiration of the blood from the subintimal space. This decompressed the true lumen, restored distal visualization, and allowed successful reentry using a dedicated technology. Utilization of this novel technique may rescue antegrade recanalization attempts complicated by large subintimal hematomas.
authors.affiliation: Saint Luke's Mid America Heart Institute, MAIH 5603, 4401 Wornall Road, Kansas City, MO 64111 USA. jgrantham@saint-lukes.org.
authors.forename: Elliot J
authors.initials: EJ
authors.lastname: Smith
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Mario
authors.forename: James C
authors.initials: JC
authors.lastname: Spratt
authors.forename: Colm G
authors.initials: CG
authors.lastname: Hanratty
authors.forename: Ranil
authors.initials: R
authors.lastname: de Silva
authors.forename: Alistair C
authors.initials: AC
authors.lastname: Lindsay
authors.forename: J Aaron
authors.initials: JA
authors.lastname: Grantham
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects; D054059:Coronary Occlusion / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods; D006406:Hematoma / Q000209:etiology / Q000601:surgery; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome