SUOH 03 Guidewire for the Management of Coronary Artery Dissection: Insights from a Multicenter Registry

Abstract

Background: In the setting of coronary artery dissection, both spontaneous and iatrogenic, fixing the intimal tear, usually with stent implantation, can be extremely challenging if the distal wire position has been lost. Common complications are mainly related to the inadvertent subintimal tracking of the guidewire while attempting to gain the distal true lumen.

Aims: To report the registry results of using the SUOH 0.3 guidewire for managing coronary artery dissection in a real-world multicenter setting.

Methods: The study population in this retrospective, multicenter, international registry included 75 consecutive patients who underwent PCI and required an antegrade wiring of a dissected coronary artery.

Results: Successful use of SUOH 0.3 was achieved in 69 (92%) patients. The use of a microcatheter was associated with a significantly higher rate of TIMI 3 flow at the end of the procedure (no microcatheter: n = 17, 81%; microcatheter: n = 52, 96.3%; p = 0.017). The first recanalization attempt was made with the SUOH 03 guidewire in 48 (64%) cases, and it was successful in 42 (87%). The overall PCI success rate was reported in 72 (96%) patients, with no significant differences among patients with different origins, mechanisms, and locations of dissection.

Conclusions: In this setting, the SUOH 0.3 guidewire provides high procedural success without additional complex techniques.

Figure 1

Technical characteristics of the SUOH 0.3 guidewire. Readapted from Gasparini et al. Catheter Cardiovasc Interv 96, E462–E466 (2020) [6].

Figure 2

Dissection etiology in the overall cohort.

Figure 3

Types of iatrogenic dissection in the overall cohort. Type A minor radiolucent areas in the lumen without impairment of flow or persistent dye staining after contrast run-off; type B luminal flap that is radiolucent and runs parallel to the vessel wall with contrast injection, but without impairment of flow or persistent dye staining after contrast run-off; type C contrast appears outside the vessel lumen as an “extraluminal cap,” and the staining appears even after contrast clears off the lumen; type D spiral radiolucent luminal filling defects, often persistent staining after contrast clears off the lumen; type E new and persistent filling defects in the lumen; type F lesions that progress to impaired flow or total occlusion.

Figure 4

SUOH 0.3 success rate at first attempt (a) and overall (b).