Microcatheter knuckle technique: A novel technique for negotiating the subintimal space during chronic total occlusion recanalization

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
Mauro CarlinoLorenzo Azzalini

Abstract

To establish if novel microcatheter knuckle technique (MKT) is feasible and efficacious in negotiating the subintimal space in difficult lesions during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). CTOs remain one of the most challenging lesion subsets in PCI. Guidewire manipulation and advancement of equipment within the subintimal space is sometimes challenging and aggressive manipulation in the subintimal space is feared, because of concern of vessel disruption and perforation. Here we introduce the MKT, for negotiating the subintimal space during challenging CTO PCI. MKT is performed by creating a wire knuckle with polymer-jacketed guidewire and positioned in the subintimal space. Subsequently, a tapered-tip, kink-resistant microcatheter is advanced towards the knuckled tip of guidewire and the guidewire is simultaneously withdrawn; creating a knuckle-shaped microcatheter tip. The MKT was considered in CTO PCIs that involved subintimal techniques where resistance to guidewire knuckle advancement was encountered. Procedures were performed between March 2013 and June 2017 at our institution. During the study period, a total of 440 CTO PCIs were performed, from which seven were treated with MKT. MKT w...Continue Reading

References

Sep 12, 2015·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Mauro CarlinoAntonio Colombo
Apr 29, 2016·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Mauro CarlinoAntonio Colombo
Jul 17, 2016·Cardiovascular Revascularization Medicine : Including Molecular Interventions·Georgios ChristopoulosEmmanouil S Brilakis

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Citations

Apr 2, 2019·Expert Review of Medical Devices·Evangelia VemmouEmmanouil S Brilakis
Jan 20, 2019·Current Treatment Options in Cardiovascular Medicine·Mahesh Anantha-Narayanan, Santiago Garcia
Nov 18, 2021·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Kyusup LeeSeong-Wook Park

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