Revascularization of Coronary Artery Chronic Total Occlusion by Active Antegrade Reverse Wire Technique

Figure 3

The second case was a patient with CTO at proximal LAD, in whom the J-CTO score was 3 points (the previous recanalization failed; with mild calcification and length >20 mm). There were a lot of branches at the opening, and the length of the occluded segment was relatively long. Retrograde angiography showed blunt bifurcation at the opening of the occluded segment, while the diagonal branch (D) and LAD showed an h-shape (a). In the present study, antegrade 7F EBU 3.75 Guiding was used for the surgery, and Fielder XTR wire was used to deliver the 135 cm Corsair (Asahi Intecc ) wire to the diagonal branch and then was replaced with Sion Blue wire. The headend of the Sion Black wire was 90° shaped at 1 mm to the headend outside the body and reflex shaped at 4 cm, which was then delivered to the diagonal branch through the KDL double cavity microcatheter. The Sion Black wire was adjusted and successfully delivered to the true lumen at distal LAD (b), after which the CTO in LAD was successfully recanalized, and a stent was implanted (c).

(a)

(b)

(c)