title: Modified contrast microinjection technique to facilitate chronic total occlusion recanalization.
abstract: OBJECTIVE
  To assess the efficacy and safety of the modified contrast microinjection technique to facilitate chronic total occlusion recanalization.
  
  
  BACKGROUND
  The success rate of chronic total occlusion percutaneous coronary intervention (CTO-PCI) does not exceed 90% even in the most experienced centres. We have previously demonstrated that a large volume of contrast injected into the subintimal space can facilitate recanalization but is limited by a risk of serious complication. The aim of this study was to assess the application, efficacy and safety of a modified contrast microinjection technique that utilizes the injection of a much smaller volume of contrast in CTO-PCI.
  
  
  METHODS
  A retrospective analysis of patients in whom the modified microinjection technique was utilised in patients undergoing CTO-PCI at five tertiary centres was conducted.
  
  
  RESULTS
  Of 1,192 patients who underwent CTO-PCI, the microinjection technique was used in 59 patients (4.7%). The majority of CTOs treated were in the right coronary artery (79.7%), were of high complexity and 35.6% of lesions had a least one previously failed PCI attempt. The modified microinjection technique was used for more than one indication in 7 (11.9%) of patients. The success rate was 81.4%. There were no procedural complications related to the use of the reported modified microinjection.
  
  
  CONCLUSIONS
  Initial experience with the modified microinjection demonstrates that it can be performed safely, is reproducible, and is broadly applicable. Whilst not required for all CTO procedures it can be a helpful adjunctive tool to increase the likelihood of success especially in complex, or refractory cases, without compromising the safety of the procedure. © 2015 Wiley Periodicals, Inc.
authors.affiliation: San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
authors.affiliation: San Raffaele Scientific Institute, Milan, Italy.|Imperial College, London, United Kingdom.
authors.forename: Neil
authors.initials: N
authors.lastname: Ruparelia
authors.affiliation: Belfast Healthcare Trust, Belfast, Northern Ireland, United Kingdom.
authors.forename: Gavin
authors.initials: G
authors.lastname: Thomas
authors.affiliation: Edinburgh Royal Infirmary, Edinburgh, United Kingdom.
authors.forename: Matthew
authors.initials: M
authors.lastname: Brooks
authors.affiliation: Central Arkansas Veterans Health System, Little Rock, Arkansas.
authors.forename: Barry F
authors.initials: BF
authors.lastname: Uretsky
authors.affiliation: University of Texas Southwestern Medical Center, Texas.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
authors.affiliation: Presbyterian Hospital/Columbia University Medical Center, New York.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Karmpaliotis
authors.affiliation: Belfast Healthcare Trust, Belfast, Northern Ireland, United Kingdom.
authors.forename: Colm
authors.initials: C
authors.lastname: Hanratty
authors.affiliation: Belfast Healthcare Trust, Belfast, Northern Ireland, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Walsh
authors.affiliation: Edinburgh Royal Infirmary, Edinburgh, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Spratt
authors.affiliation: San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D002908:Chronic Disease; D003287:Contrast Media / Q000008:administration & dosage*; D017023:Coronary Angiography / Q000379:methods*; D054059:Coronary Occlusion / Q000175:diagnosis / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008845:Microinjections; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media
keywords: chronic total occlusion; fibrous cap modification; mircoinjection; subintimal space