The Double-Blind Stick-and-Swap Technique for True Lumen Reentry After Subintimal Crossing of Coronary Chronic Total Occlusions.
Subintimal dissection and reentry techniques are widely used in chronic total occlusion (CTO) interventions; however, inability to reenter into the distal true lumen is a common cause of failure. In some patients, subintimal hematoma may develop, compressing the lumen and hindering reentry. We describe 3 CTO cases in which the distal vessel could not be visualized after subintimal crossing, in spite of attempts to decompress the subintimal hematoma. Bidirectional "blind" puncture was performed with the Stingray wire through both ports of the Stingray balloon, followed by exchange of the Stingray wire for a Pilot 200 guidewire (the "double-blind stick-and-swap" technique) achieving distal true lumen reentry.
Georgios
G
Christopoulos
Anna P
AP
Kotsia
VA North Texas Health Care System, Cardiology, 4500 South Lancaster Road, Dallas, TX 75216 USA. esbrilakis@gmail.com.
Emmanouil S
ES
Brilakis
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation / Q000379:methods; D002908:Chronic Disease; D017023:Coronary Angiography / Q000379:methods; D054059:Coronary Occlusion / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D003331:Coronary Vessels / Q000473:pathology / Q000601:surgery; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000379:methods; D016896:Treatment Outcome