Impact of the Intracoronary Rendezvous technique on coronary angioplasty for chronic total occlusion
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ORIGINAL ARTICLE
Impact of the Intracoronary Rendezvous technique on coronary angioplasty for chronic total occlusion Taro Nihei1 • Yoshito Yamamoto1 • Shun Kudo1 • Kenichiro Hanawa1 • Yuhi Hasebe1 • Yusuke Takagi1 • Yutaka Minatoya1 • Masafumi Sugi1 • Hiroaki Shimokawa2
Received: 19 February 2016 / Accepted: 17 August 2016 Japanese Association of Cardiovascular Intervention and Therapeutics 2016
Abstract The Rendezvous technique, which requires bidirectional wiring, is one of the useful methods for improving the success rate of recanalization for chronic total occlusion (CTO) in the field of peripheral intervention. Recently, advanced new devices for percutaneous coronary intervention have enabled us to perform the Rendezvous technique for peripheral as well as for coronary CTO lesions. We used the Intracoronary Rendezvous technique to perform angioplasty for coronary CTO. ‘‘Intracoronary Rendezvous’’ means that Rendezvous was achieved within the CTO lesion. From March 2009 to November 2015, 189 patients underwent CTO angioplasty at our institute, and we treated 10 patients with the Intracoronary Rendezvous technique. This technique involves crossing the Gaia series guidewire to the contralateral Corsair microcatheter located inside the plaque of CTO lesions. The majority of the CTO sites examined were in the proximal RCA (60 %). Lesion length of the occlusion was relatively long (64.4 ± 12.2 mm). Using the biplane imaging system, we were able to control the Gaia guidewires in a specific direction. Furthermore, if the antegrade and retrograde wires can be advanced into contiguous space inside the CTO lesion, we intentionally entered either wire into the contralateral Corsair microcatheter, followed by successful CTO crossing. CTO recanalization was completed for all patients without controlled antegrade
& Yoshito Yamamoto [email protected] 1
Department of Cardiovascular Medicine, Iwaki Kyoritsu General Hospital, 16 Kusehara, Mimaya-machi, Uchigo, Iwaki 973-8555, Japan
2
Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
retrograde subintimal tracking (CART) or reverse CART. No major complications occurred during hospitalization. These results indicate that the Rendezvous technique, assisted by new devices and a biplane imaging system, represents one of the primary options to achieve successful coronary CTO recanalization. (249/250 words). Keywords Rendezvous technique Chronic coronary total occlusion Percutaneous coronary intervention
Introduction Recanalization of chronic total occlusion (CTO) is one of the challenging percutaneous coronary and peripheral interventions [1, 2]. Recently, the success rate of percutaneous coronary intervention (PCI) for CTO has progressively improved because of various modifications of techniques and advances in new devices [3–5]. For example, the parallel wiring technique and the retrograde approach have been applied for guidewire advancement to the distal true lumen beyond CTO lesions [4, 6]. However, depending upon the i
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