Antegrade recanalization of chronic total occlusion

Dr. Alejandro Diego Fernández
Dr. Alejandro Diego Fernández

Haemodinamics of Hospital Italiano de Buenos Aires, Argentina.

Introduction

Microcatheters are the fundamental tool when performing chronic total occlusion (CTO) angioplasties. One of the main characteristics of the microcatheter should be the profile, which must be the smallest possible in order to cross the occlusion. At the same time, it should be noted the importance of a good hydrophilic coating, so that it can slide through the next occlusion, following the same way as the guidewire. Lastly, resistance to kinking is very important to avoid collapse of the microcatheter when removing the guide and inserting the new one. Profile, hydrophilic coating and resistance to kinking are basic and essential features for the proper functioning of microcatheters.

Patient profile

  • A 73-year-old male patient.
  • Coronary risk factors: arterial hypertension and dyslipidaemia.
  • Consultation due to effort angina, with stress echocardiogram positive for anteroapical ischaemia.

Lesion type

  • Occlusion of the mid third of the left anterior descending artery (LAD) (100% CTO), with mild calcification and little tortuosity (Figure 1).
  • The first diagonal branch was narrow and poorly developed with severe ostial stenosis.

Procedure

  • It was an antegrade procedure via the right radial approach using a XB 3.5 guiding catheter with curve.
  • The Navitian microcatheter was advanced over the Turn Track guidewire until the occlusion was reached.
  • It was exchanged for a Progress 40 guidewire with which the total occlusion was crossed with an antegrade dissection and re-entry technique (Figure 2, 3).
  • Navitian was advanced smoothly across the occlusion, the vessel was free from tortuosity and the Navitian crossed the lesion without the need for rotations (Figure 4).
  • The Navitian was used again to exchange the guidewire for a Turn Track without any problems.
  • The procedure was completed with pre-dilatation with a 2.00 mm balloon catheter and implantation of two DES (2.25x20 mm and 2.50x32 mm) (Figure 5).

Conclusion

“Navitian offers excellent hydrophilic coating and crossing profiles, making CTO crossover much easier. During the intervention, Navitian behaved optimally, and did not present any kinking problems when changing the guidewire.”

Dr. Alejandro Diego Fernandez 
Hospital Italiano de Buenos Aires, Argentina

Figures
Figure 1. LAD CTO
Figure 1. LAD CTO
Figure 2. Progress 40 wire through Navitian
Figure 2. Progress 40 wire through Navitian
Figure 3. Progress 40 advancement
Figure 3. Progress 40 advancement
Figure 4. Navitian distal position for wire exchange
Figure 4. Navitian distal position for wire exchange
Figure 5. Final Result
Figure 5. Final Result
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