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Case Reports
. 2017 Sep 29;17(1):25-28.
doi: 10.1016/j.jccase.2017.08.014. eCollection 2018 Jan.

Retrograde parallel wire technique using a dual lumen catheter can be useful for percutaneous coronary intervention with chronic total occlusion

Gen Tanabe  1 , Yuji Oikawa  1 , Junji Yajima  1 , Shunsuke Matsuno  1 , Hiroto Kano  1 , Takeshi Yamashita  1
Affiliations
Case Reports

Retrograde parallel wire technique using a dual lumen catheter can be useful for percutaneous coronary intervention with chronic total occlusion

Gen Tanabe et al. J Cardiol Cases. .

Abstract

The patient was a 61-year-old male with chronic total occlusion (CTO) of the right coronary artery (RCA). We performed percutaneous coronary intervention (PCI) to RCA-CTO with the bidirectional approach via the left anterior descending artery. In retrograde approach, the first wire entered the false lumen at the segment of severe stenosis of the CTO distal site. We performed parallel wire technique using a dual lumen catheter to avoid branch loss and succeeded to get the proximal true lumen through the second wire. When the first wire enters the false lumen, continued advancement of this wire easily should be avoided as it can collapse the true lumen and make reentry difficult. On top of that, in retrograde approach, it is difficult to perform parallel wire technique without using a dual lumen catheter. This case reveals that retrograde parallel wire technique using a dual lumen catheter is an extremely effective strategy to treat CTO. <Learning objective: The dual lumen catheter is one of the most helpful devices. However, in the field of percutaneous coronary intervention for chronic total occlusion (CTO-PCI), especially retrograde approach, the usage of them has not been established. Retrograde parallel wire technique using a dual lumen catheter may be useful for CTO-PCI.>.

Keywords: Chronic total occlusion; Dual lumen catheter; Percutaneous coronary intervention; Retrograde approach.

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Figures

Fig. 1
Fig. 1
CAG at previous hospital. (A) RCA was totally occluded at the ostium after branching the conus. White arrow heads indicate CTO lesion. White arrows indicate RSSP. (B) LAD had collateral artery from the apex to the distal PD (White arrow head). Collaterals from the septal branch were undetectable actually. CAG, coronary angiography; RCA, right coronary artery; CTO, chronic total occlusion; RSSP, right superior septal perforator; LAD, left anterior descending artery; PD, posterior descending artery.
Fig. 2
Fig. 2
Imaging findings during PCI. (A) Simultaneous left and right coronary angiography. The exit of CTO was unclear exactly. The white arrow heads indicate RV branch. (B) Tip injection through the Corsair from PD. White arrow heads indicate severe stenotic lesion. The white arrow indicate the exit of CTO. (C) Retrograde wire entered the false lumen (white arrow). (D) Retrograde parallel wire technique using dual lumen catheter. The white arrow head indicates dual lumen catheter. (E) Second wire was successfully introduced into acute marginal branch (white arrow heads). (F) Reverse-CART was performed. PCI, percutaneous coronary intervention; CTO, chronic total occlusion; RV, right ventricular; PD, posterior descending artery; CART, controlled antegrade and retrograde subintimal tracking.
Fig. 3
Fig. 3
CAG after the PCI. CAG, coronary angiography; PCI, percutaneous coronary intervention.
See this image and copyright information in PMC

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