Reverse Tip Detection: An IVUS-Guided Strategy for Retrograde Wire Crossing in CTO PCI.
Hidenari Matsumura, Michiya Kageyama, Kenichiro Shimoji et al.
✦ AI-curated · Sources linked
Case in brief
Two cases of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) were presented where conventional reverse controlled antegrade and retrograde subintimal tracking (R-CART) failed due to anatomical layer mismatch. Utilizing a novel technique called reverse tip detection (R-TD) under intravascular ultrasound (IVUS) guidance, the retrograde guidewire was redirected into the antegrade-created subintimal space, allowing successful guidewire connection and completion of the procedure without additional devices.
Diagnostic / clinical pearl
Reverse tip detection (R-TD) can effectively address failures in R-CART due to anatomical layer mismatch during CTO PCI, enhancing procedural success.
Why it matters
This technique may reduce the need for additional re-entry devices and balloon escalation, potentially improving the safety and efficiency of retrograde CTO crossing.