Access to side branches with a sharply angulated origin: usefulness of a specific wire for chronic occlusions

Abstract

Abstract Introduction and objectives: Accessing sharply angulated side branches using intracoronary guidewires sometimes poses great challenges, and even after using its distal end for accessing purposes, it usually prolapses inside the main vessel. We hereby present an easy way to perform these procedures using a specific guidewire for the management of chronic total occlusions. Methods: From January 2017 through September 2018, patients with lesions on sharply angulated side or large branches that required protection in bifurcations were approached using straight, angled tip and/or double-lumen microcatheters with regular guidewires. In cases of unsuccessful access, a specific wire designed for chronic total occlusions was used with the straight tip microcatheter after a drastic overhaul of the shape in its distal end. Results: In 9 patients access to the side branch was not achieved with the initial strategy, in 3 patients due to access inability and in the remaining 6 due to guidewire prolapse when trying to advance the microcatheter. In all 9 cases, the access could be completed using the Gaia First guidewire that combines an excellent torque with enough rigidity to prevent the prolapse of the tip. All procedures were performed without complications. Conclusions: The percutaneous coronary intervention of sharply angulated side branches can be challenging when advancing the guidewire. However, these procedures can be performed easily and quickly with a specific guidewire for the managemenf of chronic total occlusions.

Keywords

• Bifurcation
• Coronary guidewire
• Angulated lesion
• Chronic total occlusion